Effects of staged surgical treatment for forearm GUSTILO ⅢC fractures with severe wound contamination

  Background   Severe wound-contaminated forearm GUSTILO ⅢC fracture is a serious and difficult-to-treat trauma, and how to treat it is still controversial.

  Objective  To investigate the effect of staged surgery in treating severe wound-contaminated forearm GUSTILO ⅢC fracture.

  Methods   Clinical data about 12 patients with severe wound-contaminated forearm GUSTILO ⅢC fracture who were treated in the Department of Microsurgery of Hand and Foot Repair and Reconstruction at the High-tech Hospital of the First Affiliated Hospital of Anhui Medical University from May 2018 to February 2022 were retrospectively analyzed. All patients completed limb salvage with staging operation. The wound was thoroughly debrided in the first stage, then fixed with antibiotic bone cement covered with steel plate, finally filled the bone defect with antibiotic bone cement. In the second stage, the antibiotic bone cement was removed, the cancellous bone was implanted by a membrane induction technique, and the plate was replaced at the same time. The limb salvage rate, flap healing, bone healing and infection were observed, and the forearm range of motion and Enneking score were used to evaluate the recovery of forearm function.

  Results  Of the 12 cases, there were 9 males and 3 females, with age ranged from 28 to 62 years (mean age, 45 years). Limb salvage was successful in all patients with no wound or bone infection. One of the flaps was partially necrotic then healed after debridement and dressing change, while the remaining flaps all survived. After the second-stage operation, all patients had bone union, and the healing time was (8.1 ± 0.9) months. Forearm rotational range of motion improved rapidly at 1 to 6 months postoperatively and continued to improve thereafter (20.3 ± 3.2° at 1 month; 63.4 ± 6.8° at 3 months; 82.1 ± 7.3° at 6 months; 91.5 ± 6.7° at 8 months, 95.2 ± 4.6° at 12 months). Enneking score showed a stable linear upward trend (4.2 ± 0.9 at 1 month, 6.1 ± 0.8 at 3 months, 8.2 ± 1.1 at 6 months, 11.4 ± 1.4 at 8 months, 14.2 ± 1.6 at 12 months).

  Conclusion   Staged operation for severe wound-contaminated forearm GUSTILO ⅢC fractures has satisfactory curative effect and fewer complications, which is worthy of further promotion and application.