22-year-old man weight, 172 cm.), active military man, with no history of interest, who received an impact of a projectile (9 mm. caliber), by a right-handed pistol shot.
After the primary assessment and initial care, he was evacuated to the HGD "Orad and Gajías", where he was diagnosed with distal third fracture of right type, without open displacement Gustilo type III, comminute.
No lesions were observed in the rest of the examination.
Exhaustive cleaning and debridement of the wounds in the right thigh, and immobilization of the right lower limb by posterior cruropedic splint were performed.
Antibiotic prophylaxis, tetanus prophylaxis and antithrombotic prophylaxis were established.
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In the tertiary assessment of the patient in the HCD "Gómez", an axial tomography Ulla of the right was performed, with multiplanar and volumetric diagnoses.
A comminuted fracture of the distal third of the right was determined, presenting multiple small fragments displaced to the posterior compartment.
After presenting the case in a clinical session of the service, it was decided to perform surgical treatment using an external fixator.
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An external fixator XC (Orthofix®) with four femoral pins in static and monoplanar configuration under intradural regional anesthesia and sedation was surgically inserted.
No surgical or anesthetic incidents were recorded during the intervention.
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The wounded patient had a good postoperative evolution, starting a partial load 24 hours after surgery.
Five days after admission, the patient was discharged to home with subsequent outpatient clinical follow-up.
Two months after surgery, the patient had limited knee range of motion and delayed consolidation at the fracture site.
In the four-month follow-up, an absence of consolidation of the fracture focus and knee joint stiffness with a rigid tope at 30o flexion were observed by CT.
After removal of the external fixator at 18 weeks, the patient was reoperated in a programmed manner, under intradural regional anesthesia and sedation, for refreshment of fracture focus and internal fixation using a modified Ttryker tangle.
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The immediate postoperative period was uneventful, and the patient started early rehabilitation treatment programmed by the Physical Medicine and Rehabilitation Service of HCDGU.
In the postoperative follow-up, the patient had a total knee range of 110o of flexion, with normal gait and no pain.
Currently, the patient is fully reincorporated to his usual activities.
