Lower Leg Severe Open Fracture Caused by Traffic Accident - Treatment by External Skeletal Fixation: Case Report

Lower Leg Severe Open Fracture Caused by Traffic Accident - Treatment by External Skeletal Fixation: Case Report 72 years-old woman suffered an open fracture of the right tibia, as a pedestrian, when the bus tires crossed over the right foot. She was immediately transported to the Clinical Center Niš and following clinical examination, the amputation of the lower leg was advised due to extensive injury. On admission to the hospital (Clinic for Orthopedics and Traumatology), after resuscitation, arteriography of the blood vessels of the right leg was performed. Spasm of blood vessels of the right leg below the fracture was noted, but the circulation in the distal part of the lower leg and foot was preserved. After removing temporary immobilization and bandage of the lower leg, a large wound was noticed, from the toes to the popliteal crease. Primary treatment of the wound was done and tibial fracture was stabilized with external fixation (with convergent orientation of the pins). Almost the whole wound was left open, while the vital structures of the leg (the main blood vessels and nerves) were covered with local soft tissues that are adapted by situation sutures. Due to the large soft tissue destruction on the right lower leg and diabetic angiopathy, the patient was sent to special orthopedic hospital "Banjica" in Belgrade. After repeated wound debridements, external skeletal fixator was removed and the Ilizarov apparatus was placed. Soft tissue defect was covered by skin graft. In the postoperative period, patient was regularly dressed. Eight months later, the fractured tibia healed and the Ilizarov apparatus was removed. The patient was referred for rehabilitation. Following rehabilitation, patient returned to her work and everyday activities. Konkvasantni prelom potkolenice nakon gaženja autobusom, lečen metodom spoljne skeletne fiksacije. Prikaz slučaja Pacijentkinja stara 72 godine zadobila je otvoreni konkvasantni prelom desne potkolenice gaženjem točkovima autobusa. Odmah je dovezena u KC u Nišu, gde je nakon kliničkog pregleda, zbog težine povrede predložena potkolena amputacija. Po prijemu u Kliniku za ortopediju i traumatologiju, nakon reanimacije, urađena je arteriografija krvnih sudova desne noge. Registrovan je spazam krvnih sudova desne potkolenice ispod mesta preloma, ali sa prisutnom cirkulacijom u distalnom delu potkolenice i stopala. Nakon skidanja privremene imobilizacije i zavoja na potkolenici, registrovana je velika rana koja se pružala od prstiju stopla do zatkolene jame. Urađena je primarna obrada rane, koja se pružala od prstiju stopala do kolenog zgloba. Prelom je stabilizovan spoljnim skeletnim fiksatorom sa konvergentnom orjentacijom klinova. Rana otvorenog konkvasantnog preloma velikim delom je ostavljena otvorena, dok su vitalne strukture potkolenice (magistralni krvni sudovi i nervi) pokriveni mekim tkivima, koja su situacionim šavovima adaptirana. Zbog velikog oštećenja mekih tkiva desne potkolenice prilikom gaženja i dijabetične agiopatije, radi nastavka lečenja, pacijentkinja je upućena u SOHB "Banjica" u Beogradu koja raspolaže barokomorom. Nakon ponovljenih debridmana rane, spoljni skeletni fiksator je skinut i plasiran aparat po Ilizarovu. Defekt mekih tkiva pokriven je transplantatom po Tirsch-u. U postoperativnom toku bolesnica je redovno previjana. Nakon osam meseci od povređivanja, došlo je do zarastanja preloma i aparat po Ilizarovu je skinut. Bolesnica je upućena na rehabilitaciju. Po završenoj rehablitaciji, bolesnica se vratila svojim radnim i životnim aktivnostima.