The Plate Fixation In The Treatment Of Complex Forearm Open Fractures
Meriç U?urlar, MD; Fatih Kabakas, MD; Mehmet Mesut Sönmez, MD; Ramazan Erden Ertürer, Ass. Prof.; Berkan Mersa, Ass. Prof.; ?smail Bülent Özçelik, Ass. Prof.
Sisli Hamidiye Etfal Training and Research Hospital, ?stanbul, Turkey
We aimed to evaluate the safety and the outcomes of plate-screw fixation used for the immediate treatment of type-IIIC open fractures of the forearm bones with complex soft tissue injuries.
A total of 22 patients (mean age:31.6, range:24-60) treated between 2004-2010 were retrospectively analysed.All injuries resulted from high-energy traumas. Fractures were classified using AO classification. All patients had vascular and nerve injuries,and four had skin defects associated with double fractures of the forearm. All patients were operated within the first eight hours after the injury. Six patients with comminuted fractures or with bone defects underwent primary bone grafting,and one patient was treated with shortening. Primary skin closure was achieved in 17 patients, and 3 patients underwent immediate repair using skin grafts and 2 patients were repaired using immediate transposition flaps. Bony union, complications,and functional results using DASH-questionnaire, were investigated.
Mean follow-up was 28 months (range:14-70). In all patients, radius bone union was achieved. Two patients underwent a Sauve-Kapandji procedure, using the fractured segment of the ulnar diaphysis as a graft for radius. In one patient,osteosynthesis was repeated after 6 months due to nonunion. Mean period to bony union was 4.59 months (range:3-6). Superficial infection developed in three patients after the operation, and resolved with antibiotic therapy. Mean DASH-score after surgery was 25.6.
In high-energy traumas of the upper extremity associated with complex injuries with Type-IIIC forearm fractures,severity of soft tissue injuries determines the functional results in patients and it is possible to achieve a safe and efficient fixation with immediate plate-screw osteosynthesis.
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