Clinical management of Gustilo IIIB and IIIC type open fractures of forearm

Abstract

Objective To evaluate the clinical effects of different methods in the treatment of GustiloⅢB andⅢC type open fractures of forearm. Methods From December 2006 to June 2014, 28 cases of forearm open fractures with severe soft tissue injuries were treated in our department. According to Gustilo open fracture classification, 10 cases were typeⅢB and 18 cases were typeⅢC. Fractures were treated by plate fixation at first stage in 9 cases, external fixation at first stage in 4 cases, external fixation at first stage and plate fixation at second stage in 15 cases. The wounds of 7 cases were closed at first stage, and the rest 21 cases were treated by wound open with VSD coverage at first stage and free skin graft or flap coverage at second stage. Results All the patients were follow-up for 12 to 24 months with an average of 17.5 months. Postoperative osteomyelitis and bone nonunion occurred in one case which was healed 12 months after the second operation of plate fixation after complete debridement and simultaneous shortening of the radius and ulna. The healing time of other 27 cases ranged from 8 to 14 months with an average of 9.3 months. According to Anderson's forearm fracture evaluation standard, the results were excellent in 16 cases, good in 8 cases, and fair in 4 cases. Conclusion Complete debridement, reasonable fixation and one or two stage wound closure for the treatment of GustiloⅢtype forearm fracture accompanied with different degree of soft tissue injury can maximally achieve limb salvage and reduce the occurrence of postoperative infection, osteomyelitis and bone exposure. Key words: Forearm; Fractures,open; GustiloⅢtype; Severe soft tissue injury