{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:15:04Z","timestamp":1758845704809,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,9]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>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\u2019s 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 \u2018tibialising\u2019 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.<\/jats:p>","DOI":"10.1136\/bcr-2025-267339","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:30:25Z","timestamp":1758796225000},"page":"e267339","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Limb salvage in polytrauma\u2014pushing the boundaries"],"prefix":"10.1136","volume":"18","author":[{"given":"Gabriel","family":"Nierenberg","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Rambam Health Care Campus, Haifa, Haifa District, Israel"},{"name":"Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Haifa District, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Lerner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Ziv Medical Centre, Safed, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Chelnokov","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Ziv Medical Centre, Safed, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-6502","authenticated-orcid":false,"given":"Eran","family":"Keltz","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Rambam Health Care Campus, Haifa, Haifa District, Israel"},{"name":"Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Haifa District, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"2025092503301275000_18.9.e267339.1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199005000-00007"},{"key":"2025092503301275000_18.9.e267339.2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00068-014-0465-9","article-title":"Ganga hospital open injury score in management of open injuries","volume":"41","author":"Rajasekaran","year":"2015","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025092503301275000_18.9.e267339.3","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/TA.0000000000001339","article-title":"The mangled extremity score and amputation: Time for a revision","volume":"82","author":"Loja","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025092503301275000_18.9.e267339.4","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.RVW.17.00131","article-title":"Management of the Mangled Upper Extremity: A Critical Analysis Review","volume":"6","author":"Miller","year":"2018","journal-title":"JBJS Rev"},{"key":"2025092503301275000_18.9.e267339.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-015-0832-7","article-title":"Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system","volume":"16","author":"Schir\u00f2","year":"2015","journal-title":"BMC Musculoskelet Disord"},{"key":"2025092503301275000_18.9.e267339.6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11751-012-0137-4","article-title":"Management of the mangled extremity","volume":"7","author":"Prasarn","year":"2012","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2025092503301275000_18.9.e267339.7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.5005\/jp-journals-10080-1551","article-title":"Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature","volume":"17","author":"Plotnikovs","year":"2022","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2025092503301275000_18.9.e267339.8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1097\/01.TA.0000087888.01738.35","article-title":"Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities","volume":"57","author":"Lerner","year":"2004","journal-title":"J Trauma"},{"key":"2025092503301275000_18.9.e267339.9","doi-asserted-by":"publisher","DOI":"10.1007\/BF00350202"},{"key":"2025092503301275000_18.9.e267339.10","doi-asserted-by":"crossref","DOI":"10.3390\/medicina57030296","article-title":"Healing of Chronic Wounds by Copper Oxide-Impregnated Wound Dressings-Case Series","volume":"57","author":"Melamed","year":"2021","journal-title":"Medicina (Kaunas)"},{"key":"2025092503301275000_18.9.e267339.11","first-page":"205","article-title":"Tibialisation de la fibula pour une grande perte de substance osseuse. A propos d\u2019un cas [Tibialization of the fibula for a large bone loss A case report]","volume":"66","author":"Moyikoua","year":"2000","journal-title":"Acta Orthop Belg"},{"key":"2025092503301275000_18.9.e267339.12","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1007\/s00264-017-3597-9","article-title":"A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions","volume":"41","author":"Imam","year":"2017","journal-title":"Int Orthop"},{"key":"2025092503301275000_18.9.e267339.13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2106\/00004623-200101000-00002","article-title":"A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores","volume":"83","author":"Bosse","year":"2001","journal-title":"J Bone Joint Surg Am"},{"key":"2025092503301275000_18.9.e267339.14","doi-asserted-by":"crossref","first-page":"8184","DOI":"10.1038\/s41598-025-93322-9","article-title":"Impact of delayed amputation on clinical outcomes compared to that of early amputation in patients with blunt polytrauma","volume":"15","author":"Kim","year":"2025","journal-title":"Sci Rep"},{"key":"2025092503301275000_18.9.e267339.15","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/TA.0000000000003302","article-title":"The timing of amputation of mangled lower extremities does not predict post-injury outcomes and mortality: A retrospective analysis from the ACS TQIP database","volume":"91","author":"Tillmann","year":"2021","journal-title":"J Trauma Acute Care Surg"},{"key":"2025092503301275000_18.9.e267339.16","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01190"},{"key":"2025092503301275000_18.9.e267339.17","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200403000-00005"},{"key":"2025092503301275000_18.9.e267339.18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s11751-018-0316-z","article-title":"Transverse debridement and acute shortening followed by distraction histogenesis in the treatment of open tibial fractures with bone and soft tissue loss","volume":"13","author":"Salih","year":"2018","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2025092503301275000_18.9.e267339.19","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000177388.05060.a4"},{"key":"2025092503301275000_18.9.e267339.20","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/BOT.0000000000000976","article-title":"Shortening and Angulation Strategies to Address Composite Bone and Soft Tissue Defects","volume":"31 Suppl 5","author":"Pierrie","year":"2017","journal-title":"J Orthop Trauma"},{"key":"2025092503301275000_18.9.e267339.21","doi-asserted-by":"crossref","first-page":"e189","DOI":"10.1097\/BOT.0000000000001988","article-title":"Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures","volume":"35","author":"Hern\u00e1ndez-Irizarry","year":"2021","journal-title":"J Orthop Trauma"},{"key":"2025092503301275000_18.9.e267339.22","first-page":"133","article-title":"Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases","volume":"18","author":"Plotnikovs","year":"2023","journal-title":"Strategies Trauma Limb Reconstr"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267339","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:30:27Z","timestamp":1758796227000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bcr-2025-267339"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267339","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}