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+A 22-year-old man (68 kg., 172 cm.), active military, with no previous history of interest, who was hit by a projectile (9 mm. calibre), from an accidental pistol shot, at close range, in the right thigh.
+After primary assessment and initial care he was evacuated to the HGD "Orad y Gajías", where he was diagnosed with a fracture of the distal third of the right femur, open Gustilo type III, comminuted, and without displacement. In the rest of the examination no lesions were observed.
+Exhaustive cleaning and debridement of the wounds on the right thigh was carried out, and the right lower limb was immobilised by means of a posterior cruropedic splint. Antibiotic prophylaxis, tetanus prophylaxis and antithrombotic prophylaxis were instituted.
+
+In the tertiary assessment of the patient at the "Gómez Ulla" hospital, an axial CT scan of the right femur was performed, with multiplanar and volumetric reconstructions. A comminuted fracture of the distal third of the right femur was determined, with multiple small fragments displaced to the posterior compartment. After presentation of the case in a clinical session of the service, surgical treatment was decided using an external fixator.
+
+Surgical intervention was performed by placing an XCaliber external fixator (Orthofix®) with four femoral pins, in static and monoplanar configuration under intradural regional anaesthesia and sedation. No surgical or anaesthetic incidents were recorded during the operation.
+
+The injured patient had a good postoperative evolution, starting partial loading 24 hours after the operation. Five days after hospital admission, the patient was discharged home, with subsequent clinical-radiological follow-up on an outpatient basis.
+Two months after the operation, the patient had limited knee joint balance and delayed healing at the fracture site. At the four-month check-up, a CT scan revealed a lack of healing at the fracture site and knee joint stiffness with a rigid stop at 30o flexion.
+After removal of the external fixator at 18 weeks, the patient was reoperated on a scheduled basis, under intradural regional anaesthesia and sedation, for refreshing of the fracture site and internal fixation by means of retrograde femoral endomedullary nailing using a T2 nail (Stryker®), and for treatment of the knee extension contracture, a modified Judet technique quadriceplasty was performed, after which a gain in joint balance was observed, flexing the knee against gravity to 110o.
+
+The immediate postoperative period was uneventful, and the patient began early rehabilitation treatment programmed by the Physical Medicine and Rehabilitation Service of the HCDGU.
+In the controls after surgery, the patient presented a knee joint balance of 110o of flexion with full extension, with normal gait and without pain.
+At present, the patient is fully reincorporated to his usual activities.
+
+