A wide open wound exposing bone after a traffic accident — a complex injury requiring emergency surgery to preserve the limb.
HIU Hospital recently admitted a 14-year-old patient in critical condition with severe injury to the right lower leg. The wound, measuring about 10x10cm on the front and inner side of the leg, exposed a fractured bone with multiple loose fragments, crushed muscle tissue, hematoma, and debris of dirt and sand.
According to the family, about 10 hours before admission, the patient had been in a motorbike accident, colliding directly with a car.
After the injury, the patient received first aid at a local facility, including:
Compression bandaging of the wound
Temporary immobilization
Pain relievers and antibiotics
The patient was then transferred to HIU Hospital for further specialized treatment.
Diagnosis of severe injury
After examination and diagnostic evaluation, the doctors determined:
A Gustilo type IIIC open fracture of the middle third of both bones of the right lower leg
A segmental bone defect of the right tibia
A torn gastrocnemius-soleus muscle tendon of the right leg
A crushed posterior tibial vascular bundle of the right leg
A soft tissue defect of the right lower leg
This is a severe form of injury, carrying a high risk of infection and a long-term impact on mobility if not treated promptly.
Emergency overnight surgery
Immediately after a medical consultation, the Emergency – Intensive Care & Toxicology Department team, together with the Trauma and Orthopedic Surgery Department, decided to proceed with emergency surgery.
During the operation, the surgical team:
Debrided the wound, removing foreign material and crushed tissue.
Cleaned the wound with specialized solution.
Realigned the bone axis.
Stabilized it with an external fixator near the joint.
The entire procedure was supported by a modern C-arm imaging system, which helped precisely control the position and axis of the bone, ensuring the stability of the fixation system.
Post-surgery outcome
With close coordination from the Anesthesiology and Resuscitation Department team, the surgery was successfully completed after 2 hours.
During the post-operative period, the patient continued to be monitored:
The toes were pink and mobile, and the dorsalis pedis pulse was clearly palpable — the leg was fully preserved for the patient.
The patient was able to begin walking with the support of crutches.
The leg remained in an external fixator, ensuring temporary stabilization while the muscle and vascular systems recovered.
Care of the injured area continued to minimize the risk of infection.
According to Dr. Truong Dinh Duc (Level I Specialist), of the Trauma and Orthopedic Surgery Department — who directly performed the surgery, shared:
"For severe open fractures, prompt management, wound cleaning, and bone fixation play a crucial role in limb preservation and in limiting infectious complications or the risk of amputation. External fixation technique helps keep the bone axis stable, facilitates ongoing monitoring and treatment, and reduces pressure on the injured soft tissue."