Circumstances of Injury:

Evgeniy was carrying out a combat mission when enemy drones began an intense bombardment with grenades targeting his position. One of the fragments caused a serious injury to his limb. Despite the excruciating pain and shock, his comrades helped him crawl to a safer location where they applied a tourniquet to stop the bleeding. Under these extreme conditions, they had to wait for evacuation until nightfall, when it became safe enough to attempt rescue.

Diagnosis:

• Multiple trauma (May 8, 2024): Gunshot comminuted fracture of the mid-lower third of both bones in the right shin, stabilized with an external fixation device (EFD).
• Gunshot fragment injuries to both feet (foreign bodies surgically removed).
• Acute ischemia of the muscles in the right limb (tourniquet applied for 7 hours).   Details of the Injury:

  Gunshot Comminuted Fracture of Both Tibia and Fibula:

  • The fracture is characterized by multiple bone fragments with displacement, complicating the healing process.
  • External fixation device (EFD): A temporary stabilizing device used to immobilize the fractured bones and facilitate healing under complex trauma conditions.

  Gunshot Fragment Injuries to Both Feet:

  • Deep tissue damage with embedded foreign bodies (shrapnel).
  • The injury poses a high risk of infection due to the nature of the wound.

  Acute Ischemia of the Right Limb Muscles:

  • Caused by prolonged application of a tourniquet (7 hours), resulting in impaired blood supply to tissues.
  • Risks include:
    • Muscle necrosis.
    • Swelling and infection.
    • Reperfusion syndrome (complications from restoring blood flow).

Clinical Solution:

Closed Reduction and Biologically Optimized Osteosynthesis (BIOS) of the Right Tibia:

• Closed Reduction:
  • A minimally invasive procedure to restore the anatomical alignment of the fractured tibial bone fragments.
  • Performed under imaging guidance, such as X-rays, to ensure precise alignment.
• Biologically Optimized Osteosynthesis (BIOS):
  • Modern fixation techniques are employed to preserve blood supply to the bone and surrounding soft tissues.
  • Stabilization with advanced hardware, such as plates, screws, or intramedullary rods, to support healing and ensure stability.

Expected Outcomes:

1. Restoration of limb alignment and function.
2. Prevention of further ischemic damage to tissues.
3. Reduction in the risk of long-term complications, such as infections or improper bone healing.