title: Treatment of open tibial fracture with bone defect caused by high velocity missiles: a case report.
abstract: BACKGROUND
  Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications.
  
  
  METHODS
  A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis), the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy.
  
  
  CONCLUSIONS
  Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic.
authors.affiliation: Clinic of Orthopaedic Surgery and Traumatology, Clinical Center, Nis, Serbia. golubovicz@bankerinter.net
authors.forename: Zoran
authors.initials: Z
authors.lastname: Golubović
authors.affiliation: Institute for Orthopaedic Surgery Banjica', Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Vukajinović
authors.affiliation: Clinic of Orthopaedic Surgery and Traumatology, Clinical Center, Nis, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Stojiljković
authors.affiliation: Clinic of Orthopaedic Surgery and Traumatology, Clinical Center, Nis, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Golubović
authors.affiliation: School of Medicine, University of Nis, Nis, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Visnjić
authors.affiliation: School of Medicine, University of Nis, Nis, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Radovanović
authors.affiliation: School of Medicine, University of Nis, Nis, Serbia.
authors.forename: Stevo
authors.initials: S
authors.lastname: Najman
mesh_terms: D000328:Adult; D016267:External Fixators; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005597:Fractures, Open / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019857:Osteogenesis, Distraction; D013978:Tibial Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D014948:Wounds, Gunshot / Q000473:pathology / Q000601:surgery*