title: [Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: a case report].
abstract: BACKGROUND
  The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection.
  
  
  METHODS
  We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome.
  
  
  CONCLUSIONS
  Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.
authors.forename: Ivan
authors.initials: I
authors.lastname: Golubović
authors.forename: Zoran
authors.initials: Z
authors.lastname: Vukašinović
authors.forename: Predrag
authors.initials: P
authors.lastname: Stojiljković
authors.forename: Zoran
authors.initials: Z
authors.lastname: Golubović
authors.forename: Danilo
authors.initials: D
authors.lastname: Stojiljković
authors.forename: Zoran
authors.initials: Z
authors.lastname: Radovanović
authors.forename: Nenad
authors.initials: N
authors.lastname: Ilić
authors.forename: Stevo
authors.initials: S
authors.lastname: Najman
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Višnjić
authors.forename: Stojanka
authors.initials: S
authors.lastname: Arsić
mesh_terms: D000328:Adult; D016267:External Fixators; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D008297:Male; D017695:Soft Tissue Injuries / Q000601:surgery; D013978:Tibial Fractures / Q000209:etiology / Q000601:surgery*; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*