How the Injury Occurred:

On May 12, 2024, Andriy and his team were holding their positions during an intense enemy assault. Under relentless fire from mortars, FPV drones, and tank shells, shrapnel struck Andriy’s left foot. Fueled by adrenaline, he initially didn’t feel the pain, but as he emerged from cover, he realized he couldn’t stand on his injured leg, with blood streaming through his boot.

His comrades quickly applied a tourniquet, helping him crawl to the evacuation vehicle. When medics assessed the injury, they found his foot barely attached. Andriy pleaded with doctors to save his limb, and they worked tirelessly to stabilize the injury, stop the bleeding, and get him to the hospital in time.

Diagnosis:

• Multiple Explosive Trauma (MET):
  • Significant damage caused by the blast wave and shrapnel, leading to severe tissue and bone injuries.
  • High risk of infection and complicated recovery.
• Defect of the soft tissues of the medial ankle and foot surface:
  • Extensive loss of skin, muscle, and underlying tissue, exposing the joint and bone structures, increasing infection risk.
• Open infected fractures of the talus and calcaneus (heel bone):
  • The talus is critical for ankle stability, while the calcaneus supports the foot arch.
  • Infection complicates the treatment process and increases the risk of long-term disability.
• Massive bony defect of the calcaneus:
  • Significant loss of bone tissue that requires advanced reconstruction techniques.

Clinical Solution:

1. Spacer Replacement:
   • Temporary antibiotic-loaded cement spacer will be used to continue localized infection treatment and stabilize the area.
2. Spacer Removal (After Wound Healing):
   • Once the infection is resolved and the tissue is stable, the spacer will be removed to prepare the area for reconstruction.
3. Bone Grafting of the Calcaneal Defect:
   • The lost bone tissue will be replaced using:
     • Autograft: Bone harvested from the patient’s body.
     • Allograft: Donor bone.
     • Synthetic materials: Bioactive glass or other advanced substitutes to stimulate bone regeneration.
4. Arthrodesis of the Foot Joints:
   • Surgical fusion of the affected foot joints to provide stability, reduce pain, and restore weight-bearing function.
   • This procedure ensures a stable, functional foot, even if joint movement is lost.