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Dear Forum, I am taking care of a 21 y/o Marine who was shot in the leg with an M-16 from close range. He was on base (Camp Pendleton) when this happened. The patient has a medial and lateral wounds with extensive soft tissue injury (open grade 3C) with the Posterior Tibial Artery repaired on the night of injury. Fasciotomies were not necessary because his entry and exit wounds essentially exploded medially and laterally. Initial debridment left him with approximately 6" of missing bone from the mid-shaft. I ex-fixed him and have taken him back for a 2nd and 3rd look I and D. It looks like soft tissue coverage will not be too much of an issue due to his slightly shortened position as well as the large amount of dead muscle that I removed. He is post-injury day #4 and now wound is improved. I'll be able to close his medial wound directly and place a skin graft over his lateral wound in a couple days. Right now, he is stabilized in an ex-fix and I'm planning my next step. I have seen the previous similar cases from 2003 and was wondering if any of you have new ideas on how to treat this segmental defect. I haven't seen it published, but I have seen some data out of Ortho Indy showing good results with plating, followed by RIA aspirate bone grafting. I have placed an ABX spacer "log" of PMMA with hopes of him forming a pseudomembrane. However, I don't feel I have burned any bridges yet and wanted some input. Patient is sensate with good blood flow. He would like to salvage the limb. He does not smoke and is very healthy. Thanks in advance for your input. Sincerely, Roger Sohn Mission Viejo, CA < | >
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Tibia Fx - Segmental Defect
