Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:6
  • full-text downloads in 30 days:2
article: 9 from 22  
Back back to result list
Vojnosanitetski pregled
2018, vol. 75, iss. 4, pp. 422-427
article language: English
document type: Case Report
published on: 09/08/2018
doi: 10.2298/VSP160613343S
Creative Commons License 4.0
Surgical treatment of the lower leg open fracture with lesions of the main blood vessels: A case report
aClinical Centre Niš, Clinic of Orthopaedic and Traumatology
bUniveristy of Niš, Faculty of Medicine
cClinical Centre Niš, Clinic of Plastic and Reconstructive Surgery
dMilitary Medical Hospital, Niš



Virtual human osteoarticular system and its application in preclinical and clinical practice (MESTD - 41017)


Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.



Alexander, J., Piotrowski, J.J., Graham, D., Franceschi, D., King, T. (1991) Outcome of complex vascular and orthopedic injuries of the lower extremity. American Journal of Surgery, 162(2): 111-116
Bosse, M.J., Mccarthy, M.L., Jones, A.L., Webb, L.X., Sims, S.H., Sanders, R.W., Mackenzie, E.L. (2005) The insensate foot following severe lower extremity trauma. Journal of Bone and Joint Surgery-American Volume, 87(12): 2601-2608
Bosse, M.J., MacKenzie, E.J., Kellam, J.F., Burgess, A.R., Webb, L.X., Swiontkowski, M.F., Sanders, R.W., Jones, A.L., McAndrew, M.P., Patterson, B.M., McCarthy, M.L., Cyril, J.K. (2001) A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores. Journal of Bone and Joint Surgery-American Volume, 83(1): 3-14
Brinker, M.R., Bailey, D.E. (1997) Fracture Healing in Tibia Fractures with an Associated Vascular Injury. Journal of Trauma: Injury, Infection, and Critical Care, 42(1): 11-19
Chung, K.C., Saddawi-Konefka, D., Haase, S.C., Kaul, G. (2009) A Cost-Utility Analysis of Amputation versus Salvage for Gustilo Type IIIB and IIIC Open Tibial Fractures. Plastic and Reconstructive Surgery, 124(6): 1965-1973
Davidovic, L. (1997) Popliteal artery war injuries. Cardiovascular Surgery, 5(1): 37-41
Davidovic, L.B., Cinara, I.S., Ille, T., Kostic, D.M., Dragas, M.V., Markovic, D.M. (2005) Civil and War Peripheral Arterial Trauma: Review of Risk Factors Associated with Limb Loss. Vascular, 13(03): 141
Golubović, I., Vukašinović, Z., Stojiljković, P., Golubović, Z., Stamenić, S., Najman, S. (2012) Open segmental fractures of the tibia treated by external fixation. Srpski arhiv za celokupno lekarstvo, vol. 140, br. 11-12, str. 732-737
Golubović, Z., Stojiljković, P., Mačukanović-Golubović, L., Milić, D., Milenković, S., Kadija, M., Matović, Z., Turković, G., Radenković, M., Višnjić, A., Golubović, I., Stojanović, S., Vidić, G., Mitković, M. (2008) Lečenje otvorenih preloma potkolenice metodom spoljne skeletne fiksacije. Vojnosanitetski pregled, vol. 65, br. 5, str. 343-348
Gustilo, R.B., Mendoza, R.M., Williams, D.N. (1984) Problems in the Management of Type III (Severe) Open Fractures. Journal of Trauma: Injury, Infection, and Critical Care, 24(8): 742-746
Gustilo, R., Anderson, J. (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. Journal of Bone & Joint Surgery, 58(4): 453-458
Hansen, S.T. (1987) The type-IIIC tibial fracture. Salvage or amputation. Journal of Bone & Joint Surgery, 69(6): 799-800
Ilić, N., Jovanović, M., Bašić, D., Stojanović, M., Stanojević, G., Damnjanović, Z. (2014) Leg conquasation caused by petrol tiller with open lower leg fracture. Acta medica Medianae, vol. 53, br. 1, str. 34-41
Lin, C., Wei, F., Levin, L. S., Su, J., Yeh, W. (1997) The Functional Outcome of Lower-Extremity Fractures with Vascular Injury. Journal of Trauma: Injury, Infection, and Critical Care, 43(3): 480-485
MacKenzie, E.J., Castillo, R.C., Jones, A.S., Bosse, M.J., Kellam, J.F., Pollak, A.N., Webb, L.X., Swiontkowski, M.F., Smith, D.G., Sanders, R.W., Jones, A.L., Starr, A.J., McAndrew, M.P., Patterso (2007) Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury. Journal of Bone & Joint Surgery, 89(8): 1685-1692
Mcnutt, R., Seabrook, G.R., Schmitt, D.D., Aprahamian, C., Bandyk, D.F., Towne, J.B. (1989) Blunt Tibial Artery Trauma. Journal of Trauma: Injury, Infection, and Critical Care, 29(12): 1624-1627
Patzakis, M.J., Harvey, J.P., Ivler, D. (1974) The role of antibiotics in the management of open fractures. J Bone Joint Surg Am, 56(3): 532-41
Piščević, S. (1980) Injuries of blood vessels. in: Papo I., Piščević S., Funtek M., Đuknić M., Arneri V., Bervar M., i dr. [ed.] War surgery, Belgrade: Vojnoizdavački zavod, p. 429-454, Serbian
Sony, A., Tzafetta, K., Knight, S., Giannoudis, P.V. (2012) Gustilo fractures in the lower limb. Our 15-year experience. J Bone Joint Surg Br, 94(5): 698-703
Yeager, R.A., i dr. (1984) Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates. Am Surg, 50(3): 155-8