Badawi Maher, Anadani Abdulrazak, Sabboh Maya, Banna Ahmad Tawfeek, Alloush Hani
Faculty of Medicine, University of Aleppo, Aleppo, Syria.
Faculty of Medicine, University of Aleppo, Aleppo, Syria.
Int J Surg Case Rep. 2023 Nov;112:108990. doi: 10.1016/j.ijscr.2023.108990. Epub 2023 Oct 26.
The care of tibial traumatic fractures brought on by shelling injuries is extremely difficult, as these fractures are frequently comminuted, leading to a bone defect, extensive soft tissue damage, and an increased risk of bacterial contamination.
A 13-year-old male presented with trauma to the right leg following a shelling injury. He had a Gustilo IIIa open fracture with soft tissue destruction and a 7.5 cm bone loss in the distal region of the tibial shaft. Neurovascular exams were unremarkable. Primary treatment by external fixation, wound debridement, and simple suture closure was achieved. After the external fixator was removed, distraction osteogenesis was performed to deal with the bone loss. The surgical technique chosen was transport over a flexible intramedullary nail. By the end of both distraction and consolidation phases, the patient was healed with no complications, deformities, or length discrepancies.
The objective of treating tibial shelling wounds is to restore functionality and save the patient's life and limb. Neurovascular evaluation, early bone fixation, and wound care are the basic treatment. Many techniques of distraction osteogenesis can be used to restore bone loss. With lower external fixation time and complications, transport over a nail is an important one. However, using a rigid intramedullary nail in children is contraindicated, so a flexible one was used.
In this case report, we highlight the value of proper management of open leg fractures and the importance of restoring bone loss to improve the quality of life for war victims, particularly children.
炮弹伤所致胫骨创伤性骨折的治疗极为困难，因为这些骨折常为粉碎性，会导致骨缺损、广泛软组织损伤以及细菌污染风险增加。
一名13岁男性在遭受炮弹伤后出现右腿创伤。他患有Gustilo IIIa型开放性骨折，伴有软组织破坏，胫骨干远端有7.5厘米的骨质缺损。神经血管检查未见异常。通过外固定、伤口清创和简单缝合进行了初步治疗。去除外固定器后，进行了牵张成骨术以处理骨质缺损。所选用的手术技术是在弹性髓内钉上进行骨搬运。在牵张和巩固阶段结束时，患者愈合良好，无并发症、畸形或肢体长度差异。
治疗胫骨炮弹伤的目的是恢复功能并挽救患者的生命和肢体。神经血管评估、早期骨固定和伤口护理是基本治疗方法。许多牵张成骨技术可用于修复骨质缺损。骨搬运是一种重要技术，其外固定时间较短且并发症较少。然而，儿童禁忌使用刚性髓内钉，因此使用了弹性髓内钉。
在本病例报告中，我们强调了正确处理开放性腿部骨折的价值以及修复骨质缺损对改善战争受害者，特别是儿童生活质量的重要性。
