Open Forearm Fractures Research Articles

Comparison of free vascularized fibular grafts and the Masquelet technique for the treatment of segmental bone defects with open forearm fractures: a retrospective cohort study

PurposeSevere open forearm fractures commonly involve segmental bone defects. Although several methods have been proposed to treat segmental bone defects with such fractures, research comparing the radiological and clinical outcomes of free vascularized fibular grafts (FVFG) and the Masquelet technique (MT) is rare.MethodsData on 43 patients with open forearm fractures and segmental bone defects treated surgically in our hospital from January 2005 to January 2021 were retrospectively analyzed, and these patients were divided into an FVFG group (18 cases) and an MT group (25 cases). Clinical and radiological evaluations were performed regularly, and the minimum follow-up was 18 months.ResultsAll 43 patients were followed up for 18 to 190 months, with a mean of 46.93 months. The mean follow-up time was significantly longer in the FVFG group than in the MT group (p = 0.000). Bone healing time was 3–16 months, with a mean of 4.67 months. The QuickDASH score at the last follow-up was 0–38.6, with a mean of 17.71, and there was no statistically significant difference between the two groups. Operative time, hospital stay, and intraoperative bleeding for bone defect reconstruction were higher in the FVFG group compared to the MT group (p = 0.000), whereas the number of procedures was lower in the FVFG group than in the MT group (p = 0.035).ConclusionsFVFG and the MT showed satisfactory clinical results for segmental bone defects of the forearm. Compared with FVFG, the MT exhibited a lower operative time, hospital stay, and intraoperative bleeding.Level of evidenceLevel IV.Trial registration This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300067675; registered 17 January 2023), https://www.chictr.org.cn/showproj.html?proj=189458.

Intravenous Drug Abuser Treated for Chronic Infected Open Forearm Fracture with Shortening and Primary Wound Closure

Summary: Neglected and open forearm fracture wounds accompanied by shortening are complex injuries that are seldom reported in the known literature. We describe a patient with a history of chronic intravenous drug abuse (IVDA) and a neglected forearm wound with radius and ulna fractures with chronic osteomyelitis managed by limb salvage. The patient had a history of IVDA and a neglected forearm wound with fractures in both the radius and ulna, along with chronic osteomyelitis. The approach taken to manage this complex injury involved limb salvage. The case emphasizes the treatment challenges associated with patients who had IVDA and neglected their wounds. Thorough evaluation combining clinical and radiological assessments, followed by appropriate surgical planning and intervention, played a crucial role in restoring the functional status of the limb. Neglected open fracture wounds in the forearm are uncommon and have limited documentation in the existing literature. The described patient’s chronic history of IVDA and the disregarded open forearm osteomyelitis exemplify the severe consequences that can arise from injectable drug abuse in the upper extremity. In such cases, limb preservation and optimization of functional outcomes become paramount. To the best of our knowledge, this is one among the few reported cases of this nature, highlighting the significance of sharing such experiences to enhance medical understanding and inform future treatment approaches.

Efficacité de la fixation interne précoce associée à un lambeau libre pour le traitement des fractures ouvertes de l’avant-bras Gustilo IIIB

IntroductionGustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. However, there are significant differences between open bone injuries of the upper and lower extremity in terms of treatment plans. Use of internal fixation methods for open fractures is a controversial issue, as it requires early coverage of skin and soft tissue defects after radical debridement and irrigation. The optimal approach for open forearm fractures remains to be determined. The present study evaluated whether early internal fixation combined with free flap placement is effective for the treatment of Gustilo IIIB open forearm fracture. HypothesisEarly internal fixation combined with the free flap technique in the treatment of Gustilo IIIB open forearm fracture provides good consolidation results. Material and methodsFrom January 2015 to January 2020, 20 patients with Gustilo IIIB open forearm fracture treated with early internal fixation combined with free skin flap placement were retrospectively analyzed. There were 9 males and 11 females, with an average age of 40years. In all cases, the injuries were classified as Gustilo type IIIB. The area of the wounds ranged from 9×3cm to 27×10cm. Fist-stage plate fixation was adopted in 16 cases. Four patients presenting with major contamination received first-stage fixation with Kirschner wires and external fixation, and the second-stage surgery of surgical treatment included flap placement and internal fixation within 10days. The rates of limb salvage and complications were recorded. The Anderson scoring system was utilized to assess limb function. ResultsLimb salvage was successful in all 20 cases. The average length of hospital was 19 days (range, 7–28days). Four patients developed superficial infections. After debridement, the wounds were covered with skin grafts. No deep infections or osteomyelitis occurred. Three patients developed nonunion, and bone grafts achieved bone healing later. The donor skin flaps healed well, with partial pigmentation. No complete necrosis of the flaps occurred. Only the distal part of flaps became necrotic in two cases, which were then successfully treated by debridement and skin grafting. The average follow-up duration was 14.7months (range, 8–24months). According to the Anderson scoring system, 7 cases were graded as excellent, 6 cases as good, 5 cases as fair, and 2 cases as poor. ConclusionFor Gustilo IIIB type injuries, early and thorough debridement along with early internal fixation and skin flap coverage of the wound can achieve satisfactory clinical results, shorten the treatment cycle, and maximize limb function recovery. Level of evidenceIV; retrospective study without control group.

Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States.

Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures. The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment. State databases identified 130,006 forearm (1575 open) and 51,979 tibial fractures (1339 open). Surgical treatment was done in 2.6% of closed and 37.5% of open forearm fractures and 7.9% of closed and 60.5% of open tibial fractures. A national estimated total of 3,312,807 closed and 46,569 open forearm fractures were included, 59,024 (1.8%) of which were treated surgically. A total of 719,374 closed and 26,144 open tibial fractures were identified; 52,506 (7.0%) were treated surgically. Multivariable regression revealed that race and/or insurance status were independent predictors for the lower likelihood of surgery in 3 of 4 groups: Black patients were 43% and 35% less likely to have surgery after closed and open forearm fractures, respectively, and patients with Medicaid were less often treated surgically for open tibial fractures in state (17%) and nationwide (20%) databases. Disparities in pediatric forearm and tibial fracture care persist, especially for Black patients and those with Medicaid; identification of influencing factors and interventions to address them are important in improving equality and value of care.

Clinical effectiveness of early internal fixation combined with free flap technique in the treatment of Gustilo IIIB open forearm fracture

IntroductionGustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. However, there are significant differences between open bone injuries of the upper and lower extremity in terms of treatment plans. Use of internal fixation methods for open fractures is a controversial issue, as it requires early coverage of skin and soft tissue defects after radical debridement and irrigation. The optimal approach for open forearm fractures remains to be determined. The present study evaluated whether early internal fixation combined with free flap placement is effective for the treatment of Gustilo IIIB open forearm fracture. HypothesisEarly internal fixation combined with the free flap technique in the treatment of Gustilo IIIB open forearm fracture provides good consolidation results. Material and methodsFrom January 2015 to January 2020, 20 patients with Gustilo IIIB open forearm fracture treated with early internal fixation combined with free skin flap placement were retrospectively analyzed. There were 9 males and 11 females, with an average age of 40 years. In all cases, the injuries were classified as Gustilo type IIIB. The area of the wounds ranged from 9×3cm to 27×10cm. Fist-stage plate fixation was adopted in 16 cases. Four patients presenting with major contamination received first-stage fixation with Kirschner wires and external fixation, and the second-stage surgery of surgical treatment included flap placement and internal fixation within 10 days. The rates of limb salvage and complications were recorded. The Anderson scoring system was utilized to assess limb function. ResultsLimb salvage was successful in all 20 cases. The average length of hospital was 19 days (range, 7–28 days). Four patients developed superficial infections. After debridement, the wounds were covered with skin grafts. No deep infections or osteomyelitis occurred. Three patients developed nonunion, and bone grafts achieved bone healing later. The donor skin flaps healed well, with partial pigmentation. No complete necrosis of the flaps occurred. Only the distal part of flaps became necrotic in two cases, which were then successfully treated by debridement and skin grafting. The average follow-up duration was 14.7 months (range, 8–24 months). According to the Anderson scoring system, 7 cases were graded as excellent, 6 cases as good, 5 cases as fair, and 2 cases as poor. ConclusionFor Gustilo IIIB type injuries, early and thorough debridement along with early internal fixation and skin flap coverage of the wound can achieve satisfactory clinical results, shorten the treatment cycle, and maximize limb function recovery. Level of evidenceIV, retrospective study without control group.

Modern concepts of treating diaphyseal forearm fractures (literature review)

BACKGROUND: Treating patients with open forearm fractures is always a difficult task. The complexity of treating these patients is related to the anatomical and biomechanical specifics of the segment. In many cases, fragmented, unstable fractures have serious soft tissue damage due to high-energy trauma, blood supply failure, the risk of infectious complications, prolonged wound healing, compartment syndrome development, delayed union, and contracture formation.
 AIM: This article reviews the modern native and foreign literature regarding the treatment of patients with open diaphyseal forearm fractures and identifies the main problems in these injuries.
 MATERIALS AND METHODS: The analysis of modern Russian and foreign literature concerning the treatment of patients with open diaphyseal forearm fractures is presented. The analysis was performed using the medical publication databases of CyberLeninka, eLibrary, and PubMed without limiting the search depth.
 RESULTS: The high percentage of unsatisfactory results of open fractures, both anatomical and functional, especially of severe type III fractures, presents a problem. This requires the developing methods to achieve fusion to avoid infectious complications and obtain a good functional result.
 CONCLUSIONS: Surgical wound management, stabilization of the fracture in the external fixation apparatus, prevention of infection with antibiotics, and early soft tissue coverage are necessary treatment steps to reduce the infection risk. Conversion of the device to submerged fixation allows early functional treatment, including rotational movement restoration. The choice of fixation method, the timing of the conversion, and the type of internal fixation remain a matter of debate.

Reconstruction of soft tissue penile defects due to trauma using inguinal flaps

Background: We present a case of using the external pudendal artery (EPA) flap to cover the soft tissue defects of the penis following multiple trauma with penis shrinkage, corpus spongiosum and urethral injuries. Case report: A 54-year-old male patient was admitted to the hospital with multiple injuries: complex trauma with extensive scrotal and perineal skin loss, soft tissue defects of the penis with corpus spongiosum and urethral injuries, complex and open forearm fracture. The patient underwent emergency surgery to remove scrotal skin, Burry the testis in the subcutaneous pouches in the thigh, Foley sonde was placed over the bladder above the pubic bone and amputate the right hand.After that, the patient was operated on using foreskin flaps to cover corpus spongiosum defects and reconstruct the urethra. However, after about 10 days, the foreskin flap was infected and then necrotic resulting in the soft tissue defects of the penis exposing the urethral.Therefore we decided to perform surgery using the external pudendal artery (EPA) flap to solve that problem. We put sonde foley to shallow urethra and let urine pass out. The cosmetic and functional results of this foreskin-flap have been good. There was no infection, the length of the penis was maintained. The urinary stream has been normal with no urine leakage after surgery. Conclusion: The external pudendal artery flap is a good option for the treatment of patients with penile soft tissue defects. Due to its simplicity, short operation time, easy dissection, good aesthetic outcome. Therefore the external pudendal artery flap is an optimal choice for the treatment of cases of genital soft tissue defects (scrota and penis).

Bridge Plating for Comminuted Ulna Fractures.

Highly comminuted fractures of the forearm are challenging for orthopaedic surgeons to manage because of the functional importance of anatomic restoration of alignment while obtaining sufficient fixation. The use of spanning plate fixation to stabilize comminuted ulna shaft fractures allows the patient early range of motion, whereas maintaining appropriate alignment and maximizing the patient's chances for a good outcome. This video demonstrates a technique for treating a highly comminuted open forearm fracture using spanning or bridge plating techniques.

CORR Insights®: Union Rates and Reported Range of Motion Are Acceptable After Open Forearm Fractures in Military Combatants.

CORR Insights®: Union Rates and Reported Range of Motion Are Acceptable After Open Forearm Fractures in Military Combatants.

Union Rates and Reported Range of Motion Are Acceptable After Open Forearm Fractures in Military Combatants.

High-energy open forearm fractures are unique injuries frequently complicated by neurovascular and soft tissue injuries. Few studies have evaluated the factors associated with nonunion and loss of motion after these injuries, particularly in the setting of blast injuries. (1) In military service members with high-energy open forearm fractures, what proportion achieved primary or secondary union? (2) What is the pronation-supination arc of motion as stratified by the presence or absence of heterotopic ossification (HO) and synostosis? (3) What are the risks of heterotopic ossification and synostosis? (4) What factors may be associated with forearm fracture nonunion? A retrospective study of all open forearm fractures treated at a tertiary military referral center from January 2004 to December 2014 was performed. In all, 76 patients were identified and three were excluded, leaving 73 patients for inclusion. All 73 patients had serial radiographs to assess for HO and union. Only 64 patients had rotational range of motion (ROM) data. All patients returned to the operating room at least once after initial irrigation and débridement to ensure the soft tissue envelope was stable before definitive fixation. The indication for repeat irrigation and débridement was determined by clinical appearance. Patient demographics, fracture and soft tissue injury patterns, surgical treatments, neurovascular status at the time of injury, incidence of infection, heterotopic ossification (defined as the presence of heterotopic bone visible on serial radiographs), radioulnar synostosis, bony status after initial definitive treatment (union, nonunion, or amputation), and forearm rotation at final followup were retrospectively obtained from chart review by someone other than the operating surgeon. Seventy-six open forearm fractures in 76 patients were reviewed; 73 patients were examined for osseous union as three went on to early amputation, and 64 patients had forearm ROM data available for analysis. Union was determined by earliest radiology or orthopaedic staff official dictation stating the fracture was healed. Nonunion was defined as the clinical determination by the orthopaedist for a repeat procedure to achieve bony union. Secondary union was defined as union after reoperation to achieve bony union, and final union was defined as overall percentage of patients who were healed at final followup. Of the patients analyzed for union, 20 had less than 1 year of followup, and of these, none had nonunion. Of the patients analyzed for ROM, eight patients had less than 6 months of followup (range, 84-176 days). Of these, one patient had decreased ROM, none had a synostosis, and the remaining had > 140° of motion. Initial treatment resulted in primary union in 62 of 73 patients (85%); secondary union was achieved in eight of 11 patients (73%); and final union was achieved in 70 of 73 patients (96%). Although pronation-supination arc in patients without HO was 140° ± 35°, a limited pronation-supination arc was primarily associated with synostosis (arc: 40° ± 40°; mean difference from patients without HO: 103° [95% confidence interval {CI}, 77°-129°], p < 0.001); patients with HO but without synostosis had fewer limitations to ROM than those with synostosis (arc: 110° ± 80°, mean difference: 77° [35°-119°], p < 0.001). Heterotopic ossification developed in 40 of 73 patients (55%), including a radioulnar synostosis in 14 patients (19%). Bone loss at the fracture site (relative risk (RR) 6.2; 95% CI, 1.8-21) and healing complicated by infection (RR, 9.9; 95% CI, 4.9-20) were associated with the development of nonunion after initial treatment. Other potential factors such as smoking status, vascular injury, both-bone involvement, need for free flap coverage and blast mechanism were not associated. Despite a high-energy mechanism of injury and high rate of soft tissue defects, the ultimate probability of fracture union in our series was high with a low infection risk. Nonunions were associated with bone loss and deep infection. Functional motion was achieved in most patients despite increased burden of HO and synostosis compared with civilian populations. However, if synostosis did not develop, HO itself did not appear to interfere with functional ROM. Future investigations may provide improved decision-making tools for timing of fixation and prophylactic means against HO synostosis. Level III, therapeutic study.

Staged management for severe open forearm fracture: A case report

Staged management for severe open forearm fracture: A case report

Radius regeneration after open fracture and extrusion: a case report

Level 4; case report.

Management of Pediatric Grade 1 Open Forearm Fractures

Management of Pediatric Grade 1 Open Forearm Fractures

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

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

Operative versus nonoperative management of pediatric type 1 open forearm fractures: a retrospective review

Background: Considerable debate exists regarding the management of type 1 open forearm fractures in the pediatric population. The purpose of this study was to compare outcomes of nonoperative with operative treatment, and specifically to determine if there are differences in infection rates and complications. Methods: We retrospectively reviewed 155 consecutive type 1 open fractures treated at a single large pediatric hospital from 1995-2013. Inclusion criteria were patients younger than 18 yr of age with type 1 open forearm fractures with a minimum of 6 mo follow-up. Exclusion criteria were patients with type 2 or 3 injuries, inadequate documentation, and less than 6 mo follow-up. Results: From 1995-2013, 19,455 fractures of the forearm were treated. We identified 185 type 1 open fractures, 30 of which were excluded for inadequate follow-up or documentation. One hundred and nineteen patients were managed nonoperatively, and 36 patients were managed operatively with a mean age of 8.8 and 11.2 yr, respectively. There was a 0% infection rate in the nonoperative group. One patient in the operative group developed an infected nonunion. Initial sagittal deformity for the operative and nonoperative groups was 18.8 and 24.7 degrees. Residual deformity at final follow-up was significantly higher in the nonoperative group in both sagittal (P=0.031) and coronal (P=0.017) planes, although all patients fell within accepted parameters. Other than infection rate, there were no differences in complications between the two groups. The overall infection rate was 0.65%, with a 0% infection rate in the nonoperative group. Operations were performed more frequently in older children. Conclusions: Our results indicate that nonoperative management of type 1 open fractures in the pediatric population can be safe and effective.

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

PurposeOpen fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures.MethodsAn Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed.ResultsThe search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9).ConclusionsThe five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

New Nailing System Used in Open Diaphyseal Fractures

Introduction: Stabilization of open fractures is an important step in managing these injuries. Intratramedullary nailing of forearm fractures in adults is an acceptable and preferred method for internal fixation. In this study we tried to evaluate the functional end results of using a new nailing system in open diaphyseal fractures of forearm. Patients and Method: Between May 2011 and February 2015 (45 months), Fifty-three patients (106 fractures) with open diaphyseal forearm fractures had been treated and followed using new intramedullary nailing technique (Be. Te. Radial & Ulnar Nails-Santam etal,) as a method of fixation and assessing their effectiveness clinically and radiologically. There were 17 females and 36 males. Their age ranged from 25 years to 45 years (mean 32 years). Results: The final functional outcome was assessed utilizing Mayo Elbow Performance Score (MEPS) based on the parameters of pain, range of motions, stability and activities of daily life (ADL). The results of the study were: 25 (47.2%) Excellent, 20 (37.7%) Good, 6 (11.3%) Fair and 2(3.8%) Poor. Conclusion: The use of intramedullary nailing in open diaphyseal forearm fractures in adults is recommended and may be alternative to plate osteosynthesis because of minimal surgical exposure, less scarring and disfigurement, lower risk of infection, lower risk of soft tissue injury, less risk of refracture after implant removal and minimal period of convalescence.

Le fratture esposte d’avambraccio

Open fractures of the forearm represent an urgent/emergency orthopaedic condition. They are not free of complications, which can lead to upper limb disabling outcomes or amputation. The traumatologist’s goal is to carry out a correct and anatomic osteosynthesis bearing in mind the type of lesion, the instruments used for the synthesis and the consequences of his therapeutic choices. The authors of this articles describe the state of the art of open forearm fractures.

Treatment of Floating Elbow Injury

Background: A floating elbow injury (FEI, concomitant ipsilateral fractures of the humerus, ulna, and radius shafts) is rare and difficult to treat. The optimal methods for treating this complex injury have not been well defined. Materials and methods: Twenty-six adult patients with a FEI were treated between 2004 and 2010. Twenty patients were followed for at least one year and were included in this study. Each forearm fracture was treated with open reduction and plate fixation. Humeral fractures were treated with internal fixation using a plate or intramedullary nail. 6 patients received one stage operation and 14 patients were staged operation. The Mayo Elbow Performance Score was used to evaluate elbow function. Prognostic factors were studied according to injury severity and treatment methods. Results: Twenty patients (77%, 20/26) were followed for at least one year (average, 25.8 ± 10.2 month) and were included in this study. The rate of open forearm fractures (45%, 9/20) was higher than that of humeral fractures (30%, 6/20); moreover, 66.7% (10/15) of these open fractures were Gustilo type III open fractures. The union rates of the humerus, radius, and ulna were 95%, 90% and 85%, respectively. The average union times of the humerus, radius, and ulna were 17.7 ± 8.6, 25.9 ± 10, and 25.1 ± 10.8 weeks, respectively. The union time of the humerus was significantly shorter than that of the radius (p=0.008) and ulna (p=0.01). Satisfactory elbow function was observed in 13 patients (65%, 13/20). Eleven patients (55%, 11/20) had isolated or multiple nerve injuries. Radial nerve injury was most common (40%, 8/20). Recovery may be spontaneous in 62.5% of all radial nerve injury cases and 100% in patient with isolated radial nerve injury. In univariate analysis (Mann-Whitney U test), open fractures, vascular injury, nonunion, and deep infection were found to significantly associated with unsatisfactory elbow functions. Based on a Kruskal Wallis test, BPI or multiple nerve injuries was associated with significantly poorer surgical outcomes than no nerve injury and transient nerve palsy (p=0.01). Conclusions: A FEI is difficult to treat and only 65% of patients may achieve satisfactory elbow function. An unsatisfactory prognosis may be related to open fractures, BPI or multiple nerve injuries, vascular injury, nonunion, and deep infection. Radial nerve injury was most common (40%, 8/20). Recovery may be spontaneous in 62.5% of all radial nerve injury cases and 100% in patient with isolated radial nerve injury. Humeral fractures may heal faster than radial or ulnar fractures.

SURGICAL TREATMENT FOR INFECTED LONG BONE DEFECTS AFTER LIMB-THREATENING TRAUMA: APPLICATION OF LOCKED PLATE AND AUTOGENOUS CANCELLOUS BONE GRAFT.

Treatment strategies for bone defects include free bone grafting, distraction osteogenesis, and vascularized bone grafting. Because bone defect morphology is often irregular, selecting treatment strategies may be difficult. With the Masquelet technique, a fracture site is bridged and fixed with a locking plate after treating deep infection with antibiotic-containing cement, and a free cancellous bone-graft is concomitantly placed into the defects. This procedure avoids excessive bone resection. We studied 6 patients who underwent surgical treatment for deep infection occurring after extremity trauma (2004 through 2009). Ages at surgery ranged from 29 to 59 years (largest age group: 30 s). Mean follow-up was 50.7 months (minimum/maximum: 36/72 months). One patient had complete amputation of the upper extremity, 3 open forearm fractures, 1 closed supracondylar femur fracture, and 1 open tibia fracture. In all patients, bone defects were filled with antibiotic-containing cement beads after infected site debridement. If bacterial culture of infected sites during curettage was positive, surgery was repeated to refill bone defects with antibiotic-containing cement beads. After confirmation of negative bacterial culture, osteosynthesis was performed, in which bone defects were bridged and fixed with locking plates. Concomitantly, crushed cancellous bone grafts harvested from the autogenous ilium was placed in the bone defects. Time from bone grafting and plate fixation to bone union was at least 3 and at most 6 months, 4 months on average. Infection relapsed in one patient with methicillin-resistant Staphylococcus aureus, necessitating vascularized fibular grafting which achieved bone union. No patients showed implant loosening or breakage or infection relapse after the last surgery during follow-up. The advantage of cancellous bone grafting include applicability to relatively large bone defects, simple surgical procedure, bone graft adjustability to bone defect morphology, rapid bone graft revascularization resulting in high resistance to infection, and excellent osteogenesis.