Circumstances of the Injury:

On June 13, 2023, Anatolii was on duty near the village of Mala Tokmachka, carrying out a combat mission. After lunch, the enemy launched an intense mortar attack. Anatolii sought cover in a trench, but a fragment found its way, striking his left thigh.

Despite the shock and pain, Anatolii remained conscious and managed to apply a tourniquet himself to stop the bleeding. His comrades quickly evacuated him to a medical station. In the first moments, Anatolii struggled to grasp what had happened, and when he realized the severity, the thought of a possible amputation frightened him more than the pain itself.

Diagnosis:

Post-traumatic osteomyelitis of the lower third of the left femur, fistulous form. Post-operative state after metal osteosynthesis with a plate.

1. Post-traumatic osteomyelitis:
   • A chronic infection of the bone tissue caused by a previous injury and surgical intervention.
   • The infection affects the bone marrow, cortical bone, and surrounding tissues.
2. Fistulous form:
   • Characterized by the formation of fistulas (channels that discharge pus), indicating a persistent chronic inflammatory process.
3. Post-operative state after metal osteosynthesis with a plate:
   • The plate used for fixing the fracture may have contributed to the infection by introducing bacteria to the area near the implant or bone.

Clinical Plan:

Removal of the plate and placement of a cement-antibiotic spacer.

1. Plate removal:
   • The plate used during the initial surgery could be a source of the chronic infection (osteomyelitis). Removing it is essential to eliminate the persistent infection.
2. Placement of a cement-antibiotic spacer:
   • A specialized implant made from medical cement, infused with antibiotics, will be installed.

Functions of the spacer:

• Localized antibiotic delivery: Provides high concentrations of antibiotics directly at the infection site, effectively targeting the infection.
• Mechanical support: Temporarily maintains the shape and partial functionality of the affected area, preventing further bone destruction.