Circumstances of Injury:

On February 23, 2024, Maksym was executing a combat mission when, during a night approach to his position, an explosion occurred under his feet—likely a mine or a drone drop. The blast caused severe injury, but Maksym remained conscious.

For over two and a half hours, the injured defenders sheltered in a crater created by the explosion, maintaining contact with their commander and awaiting evacuation. By daylight, Maksym was successfully evacuated.

Diagnosis:

• Gunshot-induced comminuted fracture of the distal third of the right tibia:
  • With fragment displacement:
    • The bone fragments are misaligned, complicating natural healing and requiring surgical intervention.
  • Bone tissue defect:
    • A portion of the bone was lost, requiring replacement with bone grafts or synthetic materials.
  • Cement spacer installed:
    • A temporary structure that fills the defect, provides stability, and can deliver antibiotics to prevent infection.
• Stabilized with external fixation (AZF):
  • A frame that secures bone fragments externally, maintains stability, and provides wound access to reduce infection risk.

Clinical Plan:

1. Removal of External Fixation Device (AZF):
   • Removal of the AZF after achieving sufficient tissue stability and preparing the area for definitive fracture treatment.
   • Careful antiseptic treatment of pin or wire insertion sites to prevent infection.
2. Metal Osteosynthesis (MOS):
   • Definitive surgical stabilization of the tibia fracture using internal fixation techniques:
     • Plates and screws.
     • Intramedullary nails (for internal canal stabilization).
   • Goals:
     • Restore the bone’s anatomical alignment.
     • Ensure secure fixation of fragments to support proper healing.
     • Address the bone defect with appropriate grafting if needed.