Circumstances of the Injury:

On October 30, 2023, Kateryna’s life changed forever during what began as an ordinary commute home. While she was riding public transport, a sudden and unexpected strike disrupted her routine. An enemy attack caught her off guard, and she felt a sharp pain in her leg. Looking down, she realized she had been severely injured, and to her horror, she noticed that parts of her fingers were also missing.

Despite the immense pain and shock, Kateryna remained remarkably calm. She instinctively tried to stop the bleeding and focused on holding on until help arrived. Her courage and resolve exemplified her strength in facing such an unimaginable situation.

Diagnosis:

• Blast injury (October 30, 2023).
• Combined trauma:
  • Open (Grade 3B – Gustilo-Anderson) comminuted gunshot fracture of the upper third of the left femur with displacement and bone tissue defect.
  • Status post-placement of temporary cement spacer.
  • Healed gunshot wounds to the left gluteal region and anterior surface of the left thigh, with damage to the deep femoral artery and vein, as well as the sciatic and femoral nerves.
  • Status post-multiple debridements and Keystone flap reconstruction of soft tissue defects on the anterior surface of the left thigh.
  • Post-traumatic osteomyelitis of the upper third of the left femur (in unstable remission phase).
  • Post-traumatic neuropathy of the left sciatic and femoral nerves, with partial paralysis of the left lower limb (1b).
  • Status post sciatic nerve neurolysis.
  • Combined contracture of the left hip and knee joints.
  • Post-fracture syndrome (Grade 3).

Clinical Plan:

1. Removal of the temporary cement spacer:
   • A crucial step in preparing the site for definitive reconstruction while minimizing infection risks.
   • The spacer, containing antibiotics, helps maintain joint structure and supports mobility until infection is fully controlled.
2. Osteosynthesis of the upper third of the left femur:
   • A surgical procedure to stabilize the femoral fracture using an intramedullary rod.
   • Ensures alignment and promotes proper bone healing.
3. Bone defect reconstruction:
   • Performed using Bonalive bioactive glass combined with bone marrow aspirate concentrate (BMAC).
   • Bioactive glass:
     • Stimulates natural bone regeneration.
     • Provides antimicrobial properties, reducing the risk of reinfection.
   • BMAC:
     • Contains mesenchymal stem cells and growth factors to accelerate bone healing.Importance of the Articulating Spacer:
       1. Infection Control:
          • The temporary spacer releases antibiotics directly into the affected area, actively preventing infection in a high-risk zone.
       2. Preservation of Joint Structure:
          • Maintains proper spacing and alignment of joint components, preventing deformity or fusion of bones.
       3. Facilitating Mobility:
          • Allows partial movement of the limb, reducing the risk of scar tissue formation and muscle atrophy.