Golubović Ivan, Vukašinović Zoran, Stojiljković Predrag, Golubović Zoran, Stojiljković Danilo, Radovanović Zoran, Ilić Nenad, Najman Stevo, Višnjić Aleksandar, Arsić Stojanka
Srp Arh Celok Lek. 2012 Jul-Aug;140(7-8):515-20. doi: 10.2298/sarh1208515g.
The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection.
We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome.
Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.
现代火器发射的导弹可导致肢体严重骨折。胫骨高速导弹骨折的特点是组织大量破坏以及受到多种细菌的原发性污染。这些骨折的治疗常常因愈合延迟、对位愈合不佳、不愈合以及骨组织感染而变得复杂。
我们介绍一名25岁患者在遭受高速导弹创伤后胫骨骨不连的处理及初次采用外固定治疗的情况。该患者最初接受了外固定及软组织重建手术，但骨折未愈合。受伤7个月后，我们置入了米特科维奇（Mitkovic）型加压-撑开外固定器，并在腓骨截骨和自体松质骨移植后开始对骨折部位进行加压和撑开。我们记录到骨折愈合情况良好且功能恢复效果佳。
软组织包膜的污染和失活增加了高速导弹创伤后骨折感染和不愈合的风险。使用米特科维奇型加压-撑开外固定器可能是治疗此类损伤后胫骨骨不连的一种有效方法。
