Combined circular external fixation and flexible intramedullary nailing for pediatric bilateral open tibia fractures in blast injury

F. Sala, M. Domenicucci, A.M. Thabet, M.A. Agus, D. Capitani, G.M. Peretti

Article ID: 5643
Vol 34, Issue 4S3, 2020
DOI: https://doi.org/10.54517/jbrha5643
Received: 8 September 2020; Accepted: 8 September 2020; Available online: 8 September 2020; Issue release: 8 September 2020

Abstract

Management of blast injuries with open fractures and extensive soft tissue damage in pediatric patients is a challenging task even in experienced hands. This article reports the case of an 8-year-old boy with bilateral open tibia fractures and soft tissue loss due to the accidental explosion of a skyrocket. After the emergency procedures with lavage, debridement and temporary bone stabilization, we performed the definitive reconstruction surgery using a combined circular external fixation and flexible intramedullary nailing technique on both legs. This technique allowed easy access to the wounds for plastic surgery procedures and early bilateral weight bearing. All implants were removed within 6 months, the fractures healed with good axial alignment and the patient returned to his preinjury activities one year after the trauma. In this case, the combined use of circular external fixation and flexible intramedullary nailing ensured optimal fractures stabilization, minimizing the damage to the soft tissues and the obstruction for plastic surgeons. We believe that this technique should be considered in pediatric patients with open fractures of the lower limbs and extensive soft tissue injuries.


Keywords

tibia;pediatric;blast injury;circular external fixation;flexible intramedullary nailing


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