Specialty Exam Results Bloodwork and urinalysis were normal . Culture of fracture site: mixed culture of Staph aureus and E. Coli. Sensitive to 2nd or 3rd generation cephalosporins and a combination of Amoxicillin and Gentamycin Radiographs: Delayed union of the fracture is evident midshaft of the metacarpals. The fracture site is not aligned properly (probably due to the fracture not being treated properly) and has resulted in a valgus deformity below the fracture site. The fracture can be classified as open given the presence of skin lesions at the site of the fracture. The fracture is further classified as complete given that there is one fracture line extending through the bone. The presence of secondary bone healing is evident. The proliferative response is disorganized and irregular with separations existing between areas of new bone formation. The opacity of new bone formation is nonhomogenous. The presence of an infectious process is present due to the open wound and confirmed presence of Staph aureus and E. Coli at the fracture site. As the fracture is unstable, damage to the microvasculature has probably occurred. This will inhibit healing. In addition, periosteal stimulation due to fragment motion and infection has resulted in callus formation distant from the fracture. The callus has mineralized but there is minimal callus bridging the fracture gap. Since the periosteum serves as a point of attachment for tendons, the presence of a periosteal callus may be the cause of the tight bands of tissue connecting the raised toes with tissue on the dorsum of the foot that were palpated on physical exam.