Recently,
the orthopedic team at Hainan Chengmei Hospital successfully completed a highly
challenging surgical procedure for the treatment of a complex open comminuted
fracture of the distal right tibia and fibula.
After the surgery, Director Wang Kuai-sheng inspected the wound
The surgery precisely addressed the challenges of trauma treatment, effectively mitigating multiple high-risk factors such as postoperative wound infection, skin necrosis, nonunion, osteomyelitis, and the need for secondary surgery. This approach successfully preserved the affected limb for the patient.
Emergency hospitalization due to accidental fall and comminuted fracture
On the afternoon of the accident day, Mr. Ke's electric bike overturned accidentally while he was riding it, causing severe injury to his right lower leg due to a violent impact. The injured party exhibited obvious deformities at the affected area, continuous bleeding from the wound, and exposed bones. His entire right lower limb lost all mobility. His family immediately rushed him to Hainan Chengmei Hospital for emergency treatment.
The hospital immediately opened the emergency trauma green channel, and the emergency department and orthopedic surgeons conducted a joint consultation at the first time, synchronously completing imaging examination and comprehensive injury assessment to quickly determine the extent of injury.
Upon diagnosis, the patient was found to have an open comminuted fracture of the lower segment of the right tibia and fibula, which constitutes a severe orthopedic trauma. Such injuries often accompany issues such as bone fragment comminution, extensive soft tissue contusion, and severe wound contamination, making patients highly susceptible to complications such as skin necrosis, osteomyelitis, and nonunion after surgery. Additionally, considering the patient is in their prime, they have high expectations for the recovery of lower limb mobility after surgery, which further increases the overall difficulty of surgical treatment.
Opt for external fixation to avoid secondary surgery
The orthopedic team comprehensively evaluated Mr. Ke's wound injury, imaging report, and anatomical characteristics of the lower extremities, and ultimately formulated a minimally invasive external fixation brace surgical plan for him.
According to Director Wang Kuai-sheng of the Orthopedic Department, the subcutaneous soft tissue in the lower segment of the leg is thin, belonging to the typical "skin-over-bone" area, and is close to the ankle joint.
If traditional open titanium plate internal fixation surgery is employed, extensive dissection of surrounding soft tissue and implantation of titanium plates are required during the operation, which can severely disrupt the remaining local blood circulation and significantly increase the risk of complications such as poor wound healing, deep bone infection, and nonunion of fractures.
In the event of wound infection or skin necrosis, patients will also need to undergo additional secondary surgeries such as debridement, skin grafting, or flap repair; if osteomyelitis or nonunion occurs subsequently, multiple bone repairs will also be required
Surgery not only requires enduring ongoing pain and increases the burden of treatment costs, but also easily leads to limited ankle joint mobility, causing permanent impacts on future walking function.
The minimally invasive external fixation technique does not require extensive stripping of soft tissue from the wound, nor does it involve implanting titanium plates as foreign objects into the body. It can maximize the preservation of blood supply in the damaged area, thereby reducing postoperative infections, skin necrosis, nonunion, osteomyelitis, and other issues at their source. It is the optimal surgical procedure for treating this type of open comminuted fractures.
Zero error, precise insertion, hitting the target with one strike
The key difficulty of external fixation surgery lies in the precise control of the pin puncture points. This patient's fracture has fragmented bone blocks at the distal end, and the injury is adjacent to the articular surface. The operational tolerance during surgery is extremely low, and even a millimeter-level error may lead to failure in surgical reduction and fixation.
Director Wang Kuai-sheng stated that the effective area for safe needle puncture in the fractured segment of the patient is very narrow: the comminuted area at the distal end of the fracture is extremely close to the ankle joint surface. If the puncture point is too high, it is easy to crush the already fragmented bone pieces, exacerbating bone destruction; if the point is too low, the steel needle will penetrate into the ankle joint cavity, which not only fails to stabilize and fix the fracture but also causes sequelae such as joint stiffness and long-term pain. This places stringent requirements on the precision of needle placement during surgery, and the operation must be carried out with utmost accuracy.
Relying on years of experience in trauma orthopedic diagnosis and treatment, Director Wang Kuai-sheng's team, with their solid anatomical foundation and fine surgical operation experience, precisely controls the insertion position, angle, and depth of each steel needle, and completes the full set of operations including steel needle implantation, fracture reduction, and external fixation bracket assembly and fixation in one go.
After surgery, the patient's vital signs remained stable. Imaging review showed ideal alignment and linearity of the fracture ends, and the external fixation brace was securely fixed.
"When I was injured, my bone was directly exposed. I was extremely scared at that time, worried about leaving any sequela and enduring the pain of undergoing multiple secondary surgeries," Mr. Ke said. After being admitted to the hospital, the medical staff quickly completed the injury assessment, carefully compared and explained the pros and cons of various surgical options. The surgical process was efficient, and the postoperative pain was significantly alleviated. The doctor's professional skills put me at ease.
Expert Introduction
Wang KuaiSheng, Chief Physician
Orthopedic Director, Professor
High-level talents in Hainan Province
Medical expertise
Skilled in the diagnosis and treatment of orthopedic-related diseases such as hand injuries, congenital hand deformities, nerve injuries, vascular injuries, tendon injuries, wrist diseases, peripheral nerve diseases, osteoarthritis, and lumbar diseases; possesses extensive clinical experience in the diagnosis and treatment of trauma diseases such as limb trauma and limb fractures. Skilled in microsurgical techniques, capable of proficiently performing microsurgical-related orthopedic microsurgical repair surgeries such as nerve, vascular, and tendon injury repair, skin flap repair, and scar plastic surgery.
Clinic Hours
Tuesday all day (Hainan Cancer Hospital outpatient clinic)
Thursday morning and Friday all day (Hainan Chengmei Hospital outpatient clinic)