Modern concepts of treating diaphyseal forearm fractures (literature review)

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

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.

Full Text

Restricted Access

About the authors

Sergey N. Chernyaev

North-Western State Medical University named after I.I. Mechnikov; Mariinsky City Hospital

Author for correspondence.
Email: traumamariin@gmail.com
ORCID iD: 0000-0002-4328-6999
SPIN-code: 6341-3358

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

Valentin A. Neverov

North-Western State Medical University named after I.I. Mechnikov; Mariinsky City Hospital

Email: 5507974@mail.ru
ORCID iD: 0000-0002-7244-5522
SPIN-code: 2325-0152

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Anna S. Chernyaeva

Northern State Medical University

Email: chernyaeva.1997@mail.ru
ORCID iD: 0000-0001-8630-6024

MD

Russian Federation, Arkhangelsk

References

  1. Grottkau BE, Epps HR, Di Scala C. Compartment syndrome in children and adolescents. J Pediatr Surg. 2005;40:678–682. doi: 10.1016/j.jpedsurg.2004.12.007
  2. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome: who is at risk? J Bone Joint Surg. 2000;82-B:200–203
  3. Safoury Y. Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg. 2005;30-B:67–72. doi: 10.1016/j.jhsb.2004.09.007
  4. Tikhilov RM, Akhmedov BA, Ataev AR. Osteosynthesis with plates with the angular stability of screws at the treatment of the gunshot fractures of extremity long bones. Travmatologiâ I ortopediâ Rossii. 2007;2:17–23. (In Russ.)
  5. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458.
  6. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. Injury. Trauma. 1984;24:742–746. doi: 10.1097/00005373-198408000-00009
  7. Shahid MK, Robati S. The epidemiology and outcome of open distal radial fractures. J Orthop. 2013;10(2):49–53. doi: 10.1016/j.jor.2013.04.002
  8. Jawa A. Open fractures of the distal radius. J Hand Surg Am. 2010;35(8):1348–1350. doi: 10.1016/j.jhsa.2010.06.008
  9. Herman MJ, McCarthy JJ. The principles of pediatric fracture and trauma care. In: Weinstein SL, Flynn JM. editors. Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia: Wolters Kluwer; 2014. P. 1661–1693.
  10. Brighton B, Vitale M. Epidemiology of fractures in children. In: Flynn JM, Skaggs DL, Waters PM, editors. Rockwood and Wilkins’ Fractures in Children. 8th ed. Philadelphia: Wolters Kluwer; 2015. P. 1–17.
  11. Gougoulias N, Khanna A, Maffulli N. Open tibial fractures in the paediatric population: a systematic review of the literature. Br Med Bull. 2009;91:75–85. doi: 10.1093/bmb/ldp019
  12. Ömeroğlu H. Basic principles of fracture treatment in children. Eklem Hastalik Cerrahisi. 2018;29(1):52–57. doi: 10.5606/ehc.2018.58165
  13. Elia G, Blood T, Got C. The management of pediatric open forearm fractures. J Hand Surg Am. 2020;45(6):523–527. doi: 10.1016/j.jhsa.2020.02.007
  14. Dabas РМА. Treatment of shoulder and forearm fractures in patients with multiple fractures and combined trauma: dissertation. Saratov, 2010. (In Russ.)
  15. Sokolov АV. Conversion of external fixation with an intramedullary locking nail for open fractures of long bones in patients with polytrauma. NN Priorov J Traumatol Orthop. 2007;1:3–7. (In Russ.)
  16. Natoli RM, Baer MR, Bednar MS. Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures. Orthop Traumatol Surg Res. 2016;102(3):339–343. doi: 10.1016/j.otsr.2016.01.013
  17. Soong M, Schmidt S. Acute contaminated open forearm fractures treated with VersaJet Hydrosurgical Débridement. J Orthop Trauma. 2010;24(7):66–68. doi: 10.1097/BOT.0b013e3181ca48f2
  18. Dadaci M, Isci ET, Ince B, et al. Negative pressure wound therapy in the early period after hand and forearm replantation, is it safe? J Wound Care. 2016;25(6):350–355. doi: 10.12968/jowc.2016.25.6.350
  19. Takeuchi N, Mae T, Hotokezaka S, et al. A Gustilo type IIIB open forearm fracture treated by negative pressure wound therapy and locking compression plates: a case report. Fukuoka Igaku Zasshi. 2011;102(10):293–297.
  20. Liu X, Zhang H, Cen S, Huang F. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis. Int J Surg. 2018;53:72–79. doi: 10.1016/j.ijsu.2018.02.064
  21. Chernyaev SN, Neverov VA. Modern concepts of treatment of complicated diaphyseal forearm fractures (literature review). NN Priorov Journal of Traumatologyand Orthopedics. 2020;27(4):73–79. (In Russ.). doi: 10.17816/vto35163
  22. Devendra A, Velmurugesan PS, Dheenadhayalan J, et al. One-Bone forearm reconstruction: A Salvage solution for the forearm with massive bone loss. J Bone Joint Surg Am. 2019;101(15):e74. doi: 10.2106/JBJS.18.01235
  23. Kurylo JC, Axelrad TW, Tornetta 3rd P, Jawa A. Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures. J Hand Surg Am. 2011;36(7):1131–1134. doi: 10.1016/j.jhsa.2011.04.014
  24. Rai BK, Vaishya R, Agarwal AK. Spontaneous bone regeneration in an open segmental fracture of the forearm with extruded middle segment. Cureus. 2016;8(9):772. doi: 10.7759/cureus.772
  25. Zumsteg JW, Molina CS, Lee DH, Pappas ND. Factors influencing infection rates after open fractures of the radius and/or ulna. J Hand Surg Am. 2014;39(5):956–961. doi: 10.1016/j.jhsa.2014.02.008
  26. Kaufman AM, Pensy RA, O’Toole RV, Eglseder WA. Safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius. Injury. 2014;45(3):534–539. doi: 10.1016/j.injury.2013.10.006
  27. Plucknette BF, Rhee PC. An unusual variant of a floating forearm injury: a case report and review. Hand (NY). 2018;13(6):32–38. doi: 10.1177/1558944718789411
  28. Shivanna D, Aski B, Manjunath D, Bhatnagar A. A rare combination open fracture dislocation of elbow with open fracture both bones forearm with radial nerve palsy. J Orthop Case Rep. 2014;4(2):13–16. doi: 10.13107/jocr.2250-0685.159
  29. Riechelmann F, Kaiser P, Arora R. Primäre sweichteil management beioffenen frakturen [primary soft tissue management in open fracture]. Oper OrthopTraumatol. 2018;30(5):294–308. doi: 10.1007/s00064-018-0562-8
  30. Nappo KE, Hoyt BW, Balazs GC. Union rates and reported range of motion are acceptable after open forearm fractures in military combatants. Clin Orthop Relat Res. 2019;477(4):813–820. doi: 10.1097/CORR.0000000000000645
  31. Glueck DA, Charoglu CP, Lawton JN. Factors associated with infection following open distal radius fractures. Hand (NY). 2009;4(3):330–334. doi: 10.1007/s11552-009-9173-z
  32. Santoshi JA, Leshem L. Open fracture of the forearm bones due to horse bite. J Orthop Case Rep. 2014:4(1);7–10. doi: 10.13107/jocr.2250-0685.138
  33. Moed BR, Kellam JF, Foster RJ. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg. 1986;68A:1008–1017.
  34. Elsaftawy A, Jabłecki J. Acute compartment syndrome after open forearm fracture – scale of the problem and case report. Pol Przegl Chir. 2014;86(1):44–47. doi: 10.2478/pjs-2014-0008
  35. Grimsrud C, Siebler J. Small fragment locking plate as provisional internal fixation in severe open both-bone forearm fractures. J Hand Surg Am. 2014;39(8):1615–1619. doi: 10.1016/j.jhsa.2014.05.015
  36. Yang M, Zhu S, Gao Z, An G. Outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire fixation. Zhonghua Yi XueZaZhi. 2014;94(22):1729–1732. (In Chinese)
  37. Jones D, Kakar S. Adult diaphiseal forearm fractures: intramedullary nail versus plate fixation. J Hand Surg. 2011;36A:1216–1219. doi: 10.1016/j.jhsa.2011.03.020
  38. Korol SO, Matviichuk BV, Domansky AM. Extend of the surgical care to the wounded with gunshot forearm fractures at the stages of medical evacuation during terrorist operation. Тrauma. 2016;17(6):76–80. (In Russ.)
  39. Smith DK, Cooney WP. External fixation of high-energy upper extremity injuries. J Orthop Trauma. 1990;4:7–18. doi: 10.1097/00005131-199003000-00002
  40. Neverov VA, Cherniaev SN. Treatment of patients with open complicated forearm fractures. Vestn Khir Im I I Grek. 2013;172(4):54–58.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2022 Chernyaev S.N., Neverov V.A., Chernyaeva A.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies