Golubović Zoran, Vukajinović Zoran, Stojiljković Predrag, Golubović Ivan, Visnjić Aleksandar, Radovanović Zoran, Najman Stevo
Clinic of Orthopaedic Surgery and Traumatology, Clinical Center, Nis, Serbia.
Institute for Orthopaedic Surgery Banjica', Belgrade, Serbia.
Srp Arh Celok Lek. 2013 Sep-Oct;141(9-10):693-7. doi: 10.2298/sarh1310693g.
Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications.
A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis), the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy.
Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic.
高速导弹所致胫骨骨折多为粉碎性，常伴有骨缺损，这使得其愈合过程极为困难且易引发多种并发症。
一名34岁男性被半自动枪支发射的导弹近距离击中。他的左胫骨远端受伤，伴有严重的骨与软组织缺损。伤口经过初期处理后，采用Mitkovic型外固定架固定骨折，钢针呈汇聚方向。胫骨内侧区域的伤口采用二期缝合闭合，而外侧区域的伤口在施行蒂尔施植皮术后闭合。受伤6个月后，由于枪伤部位存在大量骨缺损，医疗团队安置了Mitkovic型重建外骨骼固定架，并在胫骨近端干骺端区域进行了骨皮质切开术。通过骨搬运（牵张成骨）方法，置换了胫骨的骨缺损。二次手术后7个月骨折愈合，拆除固定架，患者接受物理治疗。
对于高速导弹所致开放性胫骨骨折合并骨缺损患者，伤口的外科治疗、外固定、必要的清创、充分的抗生素治疗以及软组织和骨组织重建对于取得良好疗效至关重要。骨缺损重建可通过Mitkovic重建外固定架成功治疗。
