Transport over a flexible nail to treat a tibial defect caused by shelling injury: A case report of a 13-year-old child

The care of tibial traumatic fractures brought on by shelling injuries is extremely difficult, as these fractures are frequently comminuted, leading to a bone defect, extensive soft tissue damage, and an increased risk of bacterial contamination. A 13-year-old male presented with trauma to the right leg following a shelling injury. He had a Gustilo IIIa open fracture with soft tissue destruction and a 7.5 cm bone loss in the distal region of the tibial shaft. Neurovascular exams were unremarkable. Primary treatment by external fixation, wound debridement, and simple suture closure was achieved. After the external fixator was removed, distraction osteogenesis was performed to deal with the bone loss. The surgical technique chosen was transport over a flexible intramedullary nail. By the end of both distraction and consolidation phases, the patient was healed with no complications, deformities, or length discrepancies. The objective of treating tibial shelling wounds is to restore functionality and save the patient's life and limb. Neurovascular evaluation, early bone fixation, and wound care are the basic treatment. Many techniques of distraction osteogenesis can be used to restore bone loss. With lower external fixation time and complications, transport over a nail is an important one. However, using a rigid intramedullary nail in children is contraindicated, so a flexible one was used. In this case report, we highlight the value of proper management of open leg fractures and the importance of restoring bone loss to improve the quality of life for war victims, particularly children. •Early bone fixation and wound care are the primary management of open tibial fractures.•Bone defects may require secondary interventions such as distraction osteogenesis to restore bone loss.•Bone transport over a nail is a useful technique to reduce external fixator time in distraction osteogenesis.•Flexible intramedullary nails FIN are preferred in pediatric patients as rigid nails are contraindicated.