OTA 1997 Posters - Forearm Fractures

Poster #25

Open Fractures of the Forearm - Management and Therapeutic Outcome

Peter A. W. Ostermann, MD, PhD, Axel Ekkernkamp, MD, PhD, Michael Paul Hahn, MD, PhD, Dirk Richter, MD, Gert Muhr, MD, PhD

Bergmannsheil, Bochum, Germany

Purpose: Open forearm fractures of the forearm are severe injuries. The infection rate ranges between 3.5% and 36.5%, the non-union rate is around 15% (MOED et al., JBJS 1989). The purpose of this study was to evaluate the effect of modern therapeutic principles on open forearm fractures.

Material and Methods: Between January 1986 and December 1996, 102 compound fractures of the forearm were treated at our center. There were 41 grade I, 35 grade II and 26 grade III (15 IIIA, 8 IIIB, 3 IIIC). There were 25 Type A3 (7 A3.1, 8 A3.2, 10 A3.3), 51 Type B3 (21 B3.1, 14 B3.2, 16 B3.3) and 26 Type C (19 C1.2, 2 C1.3, 1 C2.3, 2 C3. 1, 1 C3.2, 1 C3.3) fractures. Fracture management consisted of a radical serial debridement, copious wound irrigation, fracture stabilization and i.v. antibiotics for 48 h. All wounds with compounding grade II and III were primary left open. Secondary closure was achieved with sutures (57), mesh graft (37) and flap-coverage (8). Fracture stabilization was achieved with external fixation (39), plate osteosynthesis (39), nailing (8) and material combination fix. ex. plus plate (16). One patient (Type IIIC injury) underwent primary amputation. In 32 cases an early device change was performed. Fifty-five patients received autogenous cancellous bone graft. Forty-six patients underwent dermatofasciotomy for compartment syndrome.

Results: The mean time to union was 10.4 weeks (range: 6-38). The infection rate was 3.3%. The functional outcome was rated by the Tscherne-Score: there were 67% excellent, good results, 22% fair results and 11% poor results. The unsatisfying results were related to accompanying nerve injuries and scar formation. The non-union rate was 5%.

Conclusion: Modern therapeutic principles decrease infectious complications in open forearm fractures drastically. We could lower our infection rate to 3.3% after 1986 compared to 16% between 1980 and 1986 (n=38).