Circumstances of Injury:

During a combat mission, Serhiy was holding his position when the enemy launched a massive assault. In the heat of battle, he sustained multiple injuries: a gunshot wound, shrapnel damage to his limb, a blast injury, and severe damage to his eye.

His comrades acted quickly, applying a tourniquet, dressing his wounds, and staying by his side to provide support. However, Serhiy endured another day in shock, awaiting evacuation. The pain was excruciating, and as he assessed the extent of his injuries, he realized that his index finger was barely attached by tendons. He hoped it could be saved, but the injury proved too severe.

Diagnosis:

• Aftermath of a gunshot and shrapnel wound.
• Non-union fracture with a bone defect in the distal third of the left ulna, accompanied by foreign bodies.
• Post-surgical state after metal osteosynthesis (MOS), complicated by post-traumatic osteomyelitis in a fistulous form.

Details of the Diagnosis:

1. Non-union fracture with a bone defect:
   • Significant loss of bone tissue due to shrapnel trauma.
   • Non-union indicates instability or unfavorable healing conditions, preventing the fragments from reconnecting.
2. Presence of foreign bodies:
   • Retained shrapnel or other materials in the tissues contribute to chronic inflammation.
3. Post-surgical state:
   • Previous metal osteosynthesis (MOS) did not achieve complete fracture healing, likely due to infection or inadequate stabilization.
4. Post-traumatic osteomyelitis in a fistulous form:
   • Chronic bone infection characterized by draining fistulas that discharge pus, a hallmark of persistent inflammation.

Clinical Solution:

Revision Metal Osteosynthesis (ReMOS) with Bone Defect Filling Using Bioactive Glass.

1. Revision Metal Osteosynthesis:
   • Replacement or adjustment of previous metal implants to provide stable fixation of bone fragments.
   • Restoration of the bone’s anatomical alignment to create optimal healing conditions.
2. Bone Defect Filling with Bioactive Glass:
   • Utilization of bioactive material to stimulate bone regeneration and bridge the defect.
   • Bioactive glass integrates with existing bone tissue, promoting growth while gradually being replaced by natural bone.
   • Its antibacterial properties help combat infection and prevent recurrence of osteomyelitis.