Lower limb reconstruction in a patient with an exposed Gustilo IIIB femur fracture due to an oxygen tank explosion.

Abstract

The purpose of this article is to describe the characteristics, complications and treatment of a Gustilo Anderson type IIIB open fracture, in relation to a clinical case. Introduction: We call exposed fracture any solution of continuity of a bone segment in contact with the external environment, whether or not the fracture ends are visible. These types of fractures involve high-energy injury mechanisms that cause damage to the bone (comminution) and soft tissues, which often require flaps to cover them. The risk of infection is high so they require thorough surgical cleanings and antibiotic therapy in the first hours. Clinical case: The case of a patient with an open fracture of the right femur with great soft tissue damage is presented, who received immediate surgical treatment, antibiotic coverage and use of the VAC (Vacuum-Assisted Closure) system in the wound, after multiple surgical cleanings and Adequate tissue debridement according to Scully criteria, coverage was achieved by the Plastic Surgery Service, in a multidisciplinary management for subsequent osteosynthesis with an intramedullary nail, the consolidation of the fracture and the integration of the skin flaps were achieved, upon physical examination we obtained good ambulation plus knee and hip flexion extension, achieving knee extension at 0⁰ and flexion greater than 90 ⁰. Discussion: The decision to save a severely affected limb should be made by a multidisciplinary team based on the Gustilo-Anderson classification systems and the MESS Scale to know the prognosis of the limb. Conclusions: The most important points when facing an exposed fracture are: hemodynamic stabilization of the patient, adequate evaluation of the fracture according to the aforementioned classifications and scales, early surgical debridement, early adequate antibiotic therapy, evaluation and comprehensive treatment along with other specialties such as surgery vascular, plastic surgery, neurosurgery and respect the times established for each intervention.