What the film shows

• It is an AP and lateral view of the left leg, dated 20-06-2026, with the knee at the top and the ankle at the bottom.
• A long intramedullary (IM) nail runs down the tibial canal. It has two proximal interlocking screws and two distal interlocking screws near the ankle.
• The tibia and fibula both look irregular in the mid to distal shaft. There are oblique lucent lines and uneven cortical and callus contours. I can't tell whether these are old fracture lines, healing callus or a fibular fracture.
• The nail looks centred in the canal. The nail and screws look intact, with no obvious breakage or backing out.
• The knee and ankle joints look grossly preserved on this image.

Possible diagnoses

1. Status post IM nailing of a left tibial shaft fracture. This is the most likely. Fixation is in place, and the fracture is probably in the mid to distal shaft. A fibular fracture may be present too.
2. Healing fracture with callus formation at a follow-up stage. The irregular contours and hazy density along the shaft fit this.
3. Delayed union or nonunion. Visible fracture lines at a late follow-up would point this way. The film is dated June 2026, but I don't know the surgery date, so I can't judge this.
4. Hardware-related problems. These include loosening, screw backout, nail migration, and malalignment or rotation. I see no clear sign of any of these, but a phone photo can't exclude them.
5. Infection (osteomyelitis). Look for lucency around the nail or screws and periosteal reaction. This needs clinical and lab correlation (ESR, CRP, wound status).

What would settle it

• The date of injury and surgery, and the fracture type (open or closed).
• Any symptoms: pain on weight bearing, swelling, fever or wound drainage.
• Serial X-rays to compare callus progression, plus the original radiologist's report.
• A CT scan if union is unclear.

Reference points