Limb salvage in polytrauma—pushing the boundaries

This report presents a polytrauma patient with a pelvic ring injury, multiple lower extremity fractures and a mangled left lower leg. After initial vascular repair and a temporising external fixation, the patient’s injuries were sequentially addressed. The left tibia was stabilised with an Ilizarov apparatus. Extensive bone and soft tissue damage necessitated the excision of a non-viable tibial shaft segment, enabling the creation of an artificial deformity for extensive temporary soft tissue coverage. Nursing and soft tissue management involved negative pressure wound therapy, copper-ion dressings, quilting metal sutures and wide skin grafts to build a soft tissue infrastructure to return to normal lower-leg length and alignment. The critical bone loss was managed by ‘tibialising’ the fractured fibula, conversion of the Ilizarov apparatus to an antibiotic-impregnated intramedullary nail and a custom-made brace. Rehabilitation resulted in an infection-free and pain-free limb with a near-normal gait.