Лечение пациента с открытым переломом костей предплечья и обширным дефектом костной ткани (случай из практики)

Sh.M Davirov,P.U Urinboev

doi:10.18019/1028-4427-2021-27-1-87-91

Abstract

Introduction Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. Neither internal fixation nor open reduction could be considered due to substantial bone loss and severely impaired circulation with a high risk of soft tissue necrosis and infection. We report staged management of forearm fracture using avascular autologous graft to repair the defect and maintain the forearm length. Objective Demonstrate the successful management of the double open comminuted fracture of forearm bones with extensive bony loss using Ilizarov external fixation, classical autologous grafting harvested from fibula and intramedullary (IM) nailing. Results and discussion The limb was temporarily fixed with Ilizarov frame in an extra-focal manner. An autogenous fibular graft of 11 cm was used to fill in the gap. Intramedullary nailing of the radius and ulna was produced and ulnar defect was repaired with autogenous fibular graft. IM nails were removed once the bones consolidated. The limb function was completely regained, anatomical length of the segment maintained and metal constructs removed. Conclusion Combination of different bone fixation modalities, classical autografting technique and intramedullary nailing provided complete recovery of the broken limb maintaining the function and bringing down the risk of complications to ensure a good clinical result.

Highlights

Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect
Difficulties in treatment of patients with open double comminuted forearm fractures with extensive bone defect are associated with an increased risk of pathological processes resulting from mechanical damage and infection of open wounds necessitating restoration of lost integrity between the proximal and distal radius and ulna with significant bone loss
Sklifosovsky Research Institute of Emergency Medicine, open fractures are complicated by osteomyelitis in 5.9 % of cases with the prevalence increasing to 61 % in combined, multiple injuries [4]

Summary

Introduction

Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. With the successes achieved in modern traumatology and orthopedics, repair of extended circular defects of long bones following open comminuted fractures with extensive bone loss has the great medical and social impact for reconstructive surgery. Difficulties in treatment of patients with open double comminuted forearm fractures with extensive bone defect are associated with an increased risk of pathological processes resulting from mechanical damage and infection of open wounds necessitating restoration of lost integrity between the proximal and distal radius and ulna with significant bone loss. Soft tissue injury is reported to range from 18.0 to 44.1 % in bone fractures [2, 3]. Osteomyelitis can result from open fractures of long bones, surgical treatment of closed fractures at a short term with the occurrence ranging between 5.3 and 75.4 % as a consequence of open fractures [5]

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Discussion

Conclusion