Major injury of the femur and leg with bone and soft tissue defect due to traffic accident

The authors presented a case of major injury of the leg soft tissues with a subtotal skin defect, left-sided comminuted fractures of the femur and leg in patient M., 13 years old, who got in a serious traffic accident. The major craniocerebral trauma and the remoteness from the regional centre delayed the start of qualified surgical treatment by 22 days. The first stage included a simultaneous surgery consisting in performing bridge osteosynthesis of the left femur using an internal plate of limited contact and osteosynthesis of the leg using the Ilizarov fixator with secondary debridement. The main defect of the shaft after the debridement was 25 cm. The following reconstructive intervention using bilocal osteosynthesis in order to fill the bone defect performed in the patient after necrectomy, subsequent free grafting with split-thickness skin flaps 5.5 months after the first main stage. Using this procedure the authors managed to fill the tibial defect partially, and four months later they performed the stage of free tibialization of the remaining bone defect over 10 cm using a fibular fragment obtained from the same leg. Subsequently, 19 months after the first stage of reconstruction they performed bone autografting of the femoral defect with maintaining fixation using the same plate. 2.5 years after the trauma the fixator was demounted from the leg. Consolidation in the femur and the leg was achieved, all the motions in the hip, the knee and the ankle maintained, the shortening of the lower limb remained on the involved side amounting to two cm. A good result was obtained after the performed surgical treatment with its inevitability of using the Ilizarov fixator for the leg. The serious comminuted femoral fracture and a great subtotal defect of the leg bone tissue and skin resulted in bone consolidation with soft staged using different techniques of long tubular bone reconstruction.