![]() ![]() The usual mechanisms found in bilateral leg fractures are physical stress, trauma or pathological bone fractures. The comminuted nature of the lesions reflected the bullet impact effect. The observed ballistic mechanism of this type of lesion, outside of an armed conflict, was exceptional in current practice. In the first case, it was an asymmetrical diaphyseal lesion and in the second case it was a symmetrical proximal metaphyseal lesion, which were both of non-ballistic origin. However, in Africa, two cases of bilateral fractures and simultaneous fractures of the tibia have been published in Tunisia and in Côte d’Ivoire, respectively. To our knowledge, this is the first clinical case of this type reported of an adult patient in Chad. The particularity of our clinical case was the simultaneous, asymmetrical, comminuted and bilateral ballistic fractures (middle 1/3 on the right and proximal 1/3 on the left) of the tibia-fibula bones of both legs. The patient was not brought back for a follow-up consultation. On the 45th day, ambulation was authorized with partial support of the two lower limbs, marked more on the right. Triple antibiotic therapy was initiated based on the combination of Amoxicillin + Clavulanic acid, Gentamycin and Metronidazole for 4 weeks. The patient was on an injectable anticoagulant Lovenox (Enoxaparin Sodium), which was given at a prophylactic dose for 30 days. A post-operative X-Ray image of a FESSA external fixator in the tibia and fibula bones.ģrd day by passive wheelchair mobilization and, passive and active mobilization of the ankle and knee joints. The postoperative wound care was performed daily, followed by physiotherapy starting from theįigure 3. Direct admission to the operating room and surgery took place within 6 hours post trauma. After irrigation and debridement of the wounds, osteosynthesis with a FESSA external fixator from the army health service was placed ( Figure 3). The patient was immediately transported to the hospital. In the preoperative X-ray, on the right ( Figure 2 D), a comminuted open fracture of the middle 1/3 of the tibia and fibula and on the left ( Figure 2 G), there is a comminuted open fracture of the proximal 1/3 of the tibia and fibula. No associated vascular or neurological disorders were noted. On clinical admission, we noted punctiform wounds corresponding to the entrance wounds of the bullets and to the fasciomusculocutaneous deterioration (GustiloIIIB classification) at the exit wounds of the bullets ( Figure 1). We report a case of a 29-year-old patient with simultaneous, asymmetrical, comminuted and bilateral tibia-fibula fractures that suffered multiple gunshot trauma during an attempted prison break.Ī 29-year-old patient, shot during an escape attempt from prison, was hospitalized for multiple ballistic trauma. But to our knowledge, simultaneous, asymmetrical, comminuted and bilateral fractures of the tibia and fibula bones of ballistic origin are rare in civilian orthopedic practice. The trauma can be of ballistic origin, particularly in war situations. Open bilateral leg fractures are also rare in road accidents. These are quite rare and are usually observed in young adults. These can be simultaneous, symmetrical, asymmetrical, open or closed. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.īilateral stress fractures of the legs have been reported in the literature. Evolution was favorable with ambulation starting from the 45th day. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |