Diagnosis:  Delayed union with complications

	The problems with this calf are threefold, all stemming from a fracture obtained 
when obstetric chains were applied to its legs during a difficult birth.  The primary 
problem is the delayed union which can be seen in both radiographic views.  Normally a 
fracture of this magnitude would have healed within four weeks with the callous slowly 
disintegrating over time.  However, this fracture is two and a half to three months old and 
still not properly healed.  The fracture ends are still not communicating and there are very 
large callouses on either side of the fracture.  We are calling this a delayed union versus a 
nonunion because there is still evidence of bony proliferation and callous formation.  The 
delayed union is causing instability which in turn is causing the callous to grow outward 
as opposed to bridging the fracture space.  Also, the instability of the fracture site is 
creating pathological compression on the bones involved resulting in improper bone 
growth and a valgus deformity.
	There is evidence on the radiographs of soft tissue swelling which is supportive of 
the fibrous bands felt on physical exam.  This fibrous connective tissue proliferation has 
occurred in an attempt to help stabilize the fracture area.  This has been further 
exacerbated by the prolonged improper casting causing contracture.  
	Finally, due to the improper bandaging technique there is potential for 
osteomyelitis in the bones and the joints involved.  This is evident by the positive culture 
for E.Coli and Staph aureus.  Osteomyelitis usually occurs with local contamination, 
avascular bone, and instability.  This calf is also exhibiting signs of fever, pain, and 
swelling which also support a diagnosis of acute osteomyelitis.  Although true signs are 
not seen on radiographs, soft tissue swelling plus or minus subcutaneous emphysema 
may be the only abnormalities noted.