Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 7-8, Pages: 515-520
https://doi.org/10.2298/SARH1208515G
Full text ( 346 KB)
Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report
Golubović Ivan (Ortopedsko-traumatološka klinika, Klinički centar Niš, Niš)
Vukašinović Zoran (Institut za ortopedsko-hirurške bolesti „Banjica”, Beograd + Medicinski fakultet, Beograd)
Stojiljković Predrag (Ortopedsko-traumatološka klinika, Klinički centar Niš, Niš)
Golubović Zoran (Medicinski fakultet, Niš)
Stojiljković Danilo (Medicinski fakultet, Niš)
Radovanović Zoran (Medicinski fakultet, Niš)
Ilić Nenad (Klinika za vaskularnu hirurgiju, Klinički centar Niš, Niš)
Najman Stevo (Medicinski fakultet, Niš)
Višnjić Aleksandar (Medicinski fakultet, Niš)
Arsić Stojanka (Medicinski fakultet, Niš)
Todorović Momčilo (Ortopedsko odeljenje, Zdravstveni centar, Ćuprija)
Introduction. 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. Case
Outline. 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.
Conclusion. Contamination and devitalization of the softtissue 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.
Keywords: high velocity missile fracture of the tibia, nonunion, external fixation, compression-distraction external fixator Mitkovic
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