The decision in severe upper-limb injuries: amputation or reconstruction? A retrospective case series

Abstract

Background: Large bone defects in the humerus that are associated with severe soft-tissue loss are a challenge. The aim of this study was to share the authors’ experience with the use of an Ilizarov apparatus in treating patients with severe open humeral fractures with large bone defects and soft-tissue compromise. The authors propose important prognostic factors for surgeons to consider when deciding on treating such cases. Methods: Sixteen patients with severely injured upper extremities with open humeral fractures associated with bone loss were treated with Ilizarov distraction osteogenesis in an attempt to salvage the limb. Trauma etiology were motor vehicle accidents in 12 patients and machine crushing injuries in four. All patients had open fracture Gustilo-Anderson grade IIIB. The mean bone loss was 10.67 cm (average, 5 cm to 19.5 cm). The radial nerve was completely lost at the site of injury or cut in all patients, the ulnar nerve was found in six patients, and the median nerves and brachial arteries were intact in all patients. Results: The mean age of patients was 31.1 yr (range, 21 to 42 yr). Twelve patients were men (75%). The left limb was injured in seven patients (43.75%), and all patients were right-hand dominant Average time of fixator use was 256.87 days, (range, 220 to 355). The mean follow-up period was 4.02 yr (range, 3 to 5 yr). At the end of the follow-up period, all sixteen limbs were salvaged, and bony union was achieved in all patients. Conclusions: In severely injured upper limbs, regardless of severity scores, the authors believe that reconstructive vascular impairment is the only reasons to carry out an amputation. Level of Evidence: Level IV.