Immediate internal fixation of high-energy open forearm fractures.
Eighteen patients with Gustilo and Anderson Grade III A (7), III B (8) or III C (3) open diaphyseal forearm fractures were treated with a protocol consisting of extensive primary debridement, immediate open reduction, dynamic compression plate fixation, and vascular repair when indicated. This was followed by routine redebridement at 24 to 48-h intervals until wound status allowed completion of soft tissue reconstruction. Bone grafting was performed at 8 to 10 weeks following obtainment of a closed soft tissue envelope for injuries with extensive comminution or bone loss (5 patients, 7 fractures). Subsequent procedures such as tendon transfers, scar revision, joint arthrodesis, or secondary nerve reconstruction were required in 8 of 18 patients. Minor complications related to delayed wound healing occurred in 3 individuals (15%). One deep infection of a fractured radius occurred in a patient with a floating elbow and failed free flap. Salvage with debridement, retention of hardware, and a second free flap resulted in fracture union. One patient required a second bone graft to obtain union of a segmental forearm defect. Amputation was performed in one patient following failed forearm replantation with greater than 8 h warm ischemia time. Immediate debridement and plate fixation of Grade III forearm fractures performed in conjunction with aggressive soft tissue management provided good or excellent results in 12 patients (66%) and is an acceptable treatment alternative in these difficult injuries.
Department of Orthopaedics, University of Rochester, New York, NY 14642.
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Jones
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D014656:Vascular Surgical Procedures