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High-Risk Case: Insulin Dependent Brittle Diabetic OTA/AO 42-A1 Fracture

Case Information: Female, age 46, insulin-dependent brittle diabetes with poorly controlled blood sugar (elevated HbA1c).  Fall from standing height resulted in a closed tibial fracture, OTA/AO 42-A1.

The patient was slow to weight-bear for two weeks despite encouragement but was compliant thereafter.

RUST scores at 6 and 12 weeks were 9 and 11.

On the 12-week CT scan, the callus was clearly bridged, and the limb had achieved a virtual torsional rigidity score of VTR = 103% (f ractured/intact), which indicates that healing had progressed to equivalence with the structural rigidity of the intact limb.

Clinical union occurred by 12 weeks and the patient had no pain and returned to all activities with no restrictions. Given that insulin-dependent diabetes is associated with a documented statistically significant increase in the risk of nonunion and delayed union, this is an excellent healing result.