case_images: PMC5974666_01
case_images: Computed tomographyscout shows the floating knee IIB according to Fraser.
case_images: JOCR-8-3-g001.jpg
case_images: PMC5974666_01_JOCR-8-3-g001.jpg
case_images: F1
case_images: At 4:30 am, a 23-year-old patient arrived at our drug enforcement administration, after a high kinetic energy car accident (car against the wall) in orotracheal intubation with a Glasgow coma scale (GCS) of 11/15, mangled extremity severity score 4 points for the femur, and 3 points for the leg, and an injury severity score of 24 points:oderate concussion, moderate splenic ulcerations, supra-intercondylar fracture of the femur (3.3-C1 according to AO) left exposed Gustilo Anderson (GA) IIIB and bone loss of the metaphyseal area >50% and shaft fracture(Fig. 1 and 2) with a third fragment (4.2- B2 according to AO) exposed GA 3B(Fig. 1).
case_images: Intr operative fluoroscopy showing bone loss more than 50% at the metashaft distal of the left femur.
case_images: JOCR-8-3-g002.jpg
case_images: PMC5974666_01_JOCR-8-3-g002.jpg
case_images: F2
case_images: At 4:30 am, a 23-year-old patient arrived at our drug enforcement administration, after a high kinetic energy car accident (car against the wall) in orotracheal intubation with a Glasgow coma scale (GCS) of 11/15, mangled extremity severity score 4 points for the femur, and 3 points for the leg, and an injury severity score of 24 points:oderate concussion, moderate splenic ulcerations, supra-intercondylar fracture of the femur (3.3-C1 according to AO) left exposed Gustilo Anderson (GA) IIIB and bone loss of the metaphyseal area >50% and shaft fracture(Fig. 1 and 2) with a third fragment (4.2- B2 according to AO) exposed GA 3B(Fig. 1).
case_images: (a, b) Bridging knee external fixation for damage control.
case_images: JOCR-8-3-g003.jpg
case_images: PMC5974666_01_JOCR-8-3-g003.jpg
case_images: F3
case_images: The patient was treated in emergency with a bridge femorotibial external fixator after extensive cleaning and debridement of open fractures(Fig. 3a and b).
case_images: X-rayspost-operative shows the reduction and fixation of fracture and bone loss with external metal plate and screws and medial allograft bone strut.
case_images: JOCR-8-3-g004.jpg
case_images: PMC5974666_01_JOCR-8-3-g004.jpg
case_images: F4
case_images: The surgical access chosen was the lateral subvastus to preserve the perforating arteries(Fig. 4).
case_images: The X-rays (A and B) follow-up at 3 months shows good bone consolidation processes of the femur, poor tibial (C and D). Intramedullary nailing of tibial shaft at 3 months after injury (E and F).
case_images: JOCR-8-3-g005.jpg
case_images: PMC5974666_01_JOCR-8-3-g005.jpg
case_images: F5
case_images: The patient was subjected to the intervention of removal of the external fixator and intramedullary nailing of the tibia 3 months after the first surgery(Fig. 5).
case_images: Excellent functional recovery 48 months after injury.
case_images: JOCR-8-3-g006.jpg
case_images: PMC5974666_01_JOCR-8-3-g006.jpg
case_images: F6
case_images: At follow-up at the past 36 months, a year after the removal of plaque and nail, the patient showed KOOS 100 points, a SF-36 out of 100 points(Fig. 6), and R.U.S.T and R.U.S.T 4 out of 4 points(Fig. 7).
case_images: The X-rays shows the perfect consolidation and the femur bone regeneration.
case_images: JOCR-8-3-g007.jpg
case_images: PMC5974666_01_JOCR-8-3-g007.jpg
case_images: F7
case_images: At follow-up at the past 36 months, a year after the removal of plaque and nail, the patient showed KOOS 100 points, a SF-36 out of 100 points(Fig. 6), and R.U.S.T and R.U.S.T 4 out of 4 points(Fig. 7).