PMC6061498_01
Trauma CT demonstrating comminuted mid-shaft tibial fracture with partial bone loss
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Fig1
Upon presentation, the patient underwent a complete trauma assessment and was found to have sustained the following injuries giving him an injury severity score (ISS) of 22:right flail chest with rib fractures 2-7, right scapular fracture, lumbar vertebral body fracture, sacral alar fracture, Rockwood grade 2/3 dislocation of the acromioclavicular joint (ACJ), Gustillo and Anderson grade IIIB open fracture with partial bone loss of the tibia and fibula (see Fig. 1), and an open right mid-foot fracture.
Two weeks following application of circular frame, maturing skin grafts and healthy free ALT flap
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Fig2
The flap was anastamosed end-to-side onto the posterior tibial artery, and end-to-end onto the venae commitantes (see Fig. 2).
AP x-ray of the right lower leg following removal of circular frame demonstrating new bone formation and adequate alignment. Surgical clips at the site of flap anastomosis are visible on the medial surface
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Fig3
The frame was removed at 10 months (see Figs. 3 and 4) and at 15 months he weight-bears without a cast or boot and has resumed his pre-injury activities with excellent soft tissue cover.
Two weeks following circular frame removal showing healing at the site of pin removal, and viable flap coverage and limb salvage
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Fig4
The frame was removed at 10 months (see Figs. 3 and 4) and at 15 months he weight-bears without a cast or boot and has resumed his pre-injury activities with excellent soft tissue cover.