PATIENT LUIS GONZALEZ. 10 MONTHS AND A HALF OF EVOLUTION, PATIENT was treated with amnion.

. LUIS GONZALEZ

AGE: 39 YEARS AT TIME OF ACCIDENT. CURRENTLY 40 YEARS.

ACCIDENT DATE: 03 MAY 2009.

39 year old patient suffered a traffic accident while driving a motorcycle.

Severe open fracture of his right leg. Exhibition Grade 3C.

Fractured tibia with intermediary segment and explosion of it, and open fracture of Peronne, to pinpoint intermediary segment, which after being examined in the operating room had a large attrition of muscle and soft tissue and loss section of the extensor digitorum . Fibula was stabilized with a Kirschner wire.

He made an emergency surgical cleaning block. He put a precarious context as no material was available for complete fixation.

We attempted to align the ends of the flexor digitorum.

He was admitted to the Surgery Department of Regional Hospital of Salto. Is given antibiotics, and gentamicin penincilina in the early stages and then ciprofloxacin and clindamycin.

RX. Front. shows the primary fixation was performed with tubular external fixator and Kirschner wire.

The same profile.

At 15 days, no element of infection and without being required reoperation, the patient was transferred to Montevideo for the purpose of a montage of more stable external fixation for fracture and secure it presented.

RX. Front. Shows a more complex framework that was put to the patient.

RX. Profile. Are the same framework.

He was the only patient who made a free skin graft.

Thigh donor site on the same side.

Appearance wounds presenting after free skin graft.

FIRST APPLICATIONS OF NIMA DRESSINGS BEGAN ON 27 JULY 2009.

Appearance of wounds on 07 September 2009. Nearly two months after starting with amnion dressings since the September 24 will be shifted to a functional treatment of fracture retiring external fixators.

On the same date to remove the Kirschner fibula stabilized.

RX. Front. in this day removed the stabilizing Kirschner Guja fibula fracture The image above intermediate segment presents clear signs of consolidation, but not the lower fracture in this segment.

This posed two options:

-Continue treatment with external fixator and cancellous make contribution to the lower fracture.

"Trying to make functional treatment.

To perform the latter was necessary to know the status of bone vascularization, for which bone scintigraphy was requested.

The affected leg scan shows intense uptake of the radioactive isotope which had tilted the balance towards the beginning of a functional treatment.

On 24 September 2009 were removed the external fixator and he prepared a plaster made crura pedal, allowing partial support crutches prior to the making of a plaster type PTB

It enabled the patient to improve their autonomy in running apart from the crutches.

Rx. Front and profile. A month and a half have started with the cast type PTB There is a clear increase in corn? Seo higher in the outbreak and the appearance? N an attempt consolidaci image? N in the lower focus. Gaiter functional. It remained for a month. On January 15 of 2010 was passed to a spat with no shield.

On February 17th 2010 the cast is removed completely.

RX. Front. 20-03-10 - consolidated fracture.

RX. Profile. Fracture consolidated. Exuberant callus consolidation typical periosteal functional by the cast. It makes us think that the choice of functional treatment in the final stages was adequate.

They put one boot with Unna paste because when the patient wanders far, presents difficulties of such severe injuries and wander long without normally. The patient is still under surveillance. The fracture is well established and soft tissue in a situation totally unacceptable. It is the only patient who received free skin graft, but I think the amnion remained the main actor, giving us time and protection for possible infection of the patient.