25 year old Ms. Praveena, an ambitious girl, completed her MBA after engineering, and was working in an IT firm. Engaged to her childhood friend, she was off to Pondicherry with him for a vacation on a two wheeler, when they met with a road traffic accident.

While her fiancé escaped with few abrasions, she sustained fractures of both of her leg bones. While the right one was relatively simpler, the left leg bone fracture was ghastly. It had got shattered into numerous pieces, with the overlying muscles and skin tissue ruptured and lost. Thus the broken leg bone fragments were exposed to the outside environment and were impregnated with the road side contamination.

Immediate Treatment:

She was rushed to MIOT for treatment. She was thoroughly evaluated and underwent “Emergency Wound debridement”, a surgery where in the contamination in the wound which would put her in high risk of infection was thoroughly cleaned and the left leg bone fragments were stabilised externally with metal framework known as “external fixator”, where as the right leg leg bone was fixed with a metal rod (intra-medullar nailing). After performing a relook surgery into the left leg wounds a few days later, the underlying leg bone was fixed with a plate.

Shattered dreams:

Poor Ms. Praveena who was recovering from the physical and mental suffering caused by the ravaging injury of such gravity, got a setback in her relationship as her fiancé who had promised to accompany her throughout the journey of life, left her before it even got started.

Adding more pain to it, underlying bone in her left leg was getting exposed due to loss of soft tissues. It was filled up by 2 plastic surgical procedures namely “Muscle flap cover” and “Skin grafting”. After few days of hospitalisation the external metal framework (external fixator) was removed off the left leg, she was extensively rehabilitated with physiotherapy, mobilised with crutches and was discharged.

Persistent Infection:

She was being followed up on a monthly basis in the outpatient department. Usually fractures of leg bones take about 3 to 4 months to heal. While doctors were happy with progression of the healing of Ms. Praveena’s right side leg bone, the healing on the left side was lethargic. A CT scan was done at that point to look into the cause for the same, which confirmed what the doctors had suspected. Despite the repeated extensive debridement procedures, some infection had fostered into a small dead bony fragment at the fracture site which was hindering the local fracture healing.

She was admitted again, and underwent “radical sequestrectomy”, where in all the dead and infected bony fragments were removed from her leg. The gap which was thus left behind in the leg bone was filled up with Rib grafting and the whole construct was stabilised with a strong Titanium Plate.

RIB GRAFTING is a sophisticated procedure in which one of the patient’s own ribs are surgically removed, is cut into small pieces which are used to fill up large bony defects.

Recovery:

Following up this time, the trauma team was happy to know that Ms. Praveena had not only recovered emotionally from the relationship loss but also fought the infection leading to sound bone healing in the left leg bone just like in the right one. 10 weeks later, She was back on her feet walking without crutches, had started going to the office and with her grit and determination, within the same year got promoted to the post of group leader in her company.

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