The use of external fixation in complex trauma of upper limb

Corain, Massimo; Carità, Enrico; Vassia, Lara; Cugola, L

doi:10.1007/s12306-007-0001-8

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…There is a growing trend towards intramedullary fixation of forearm fractures in children [22]. Additionally the use of an external fixator has limited indications and is not seen as a first-line treatment in management of forearm diaphyseal fractures in children [23].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Fixation of Fractures of Forearm Bones in Children

Ameen¹,

Abdulrahman²,

Megahed³

et al. 2019

Zagazig University Medical Journal

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Background: Forearm fractures are the most common fractures in children, representing 40 to 50 percent of all childhood fractures. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. Methods: Between February 2017 and February 2018, 12 patients who are younger than the age of closure of epiphysis exhibited to Zagazig General Hospital suffering from displaced fractures of shaft of both bones of the forearm, all patients were treated by closed reduction and percutaneous intramedullary fixation by K-wires with a period of (6 -12) month with mean 6.6 moths follow up. Results: At the end of follow up, the operations were succeeding in all cases. According to Price et al criteria, 8 patients (66.7%) were classified as excellent results, 4 patients (33.3%) were classified as good results and no patients were classified as fair or poor results. No complication detected after the end of follow up period. Conclusions: Closed reduction percutaneous intramedullary fixation of pediatric displaced diaphyseal forearm fractures by K-wires is a safe, reliable, minimally invasive procedure and effective method of treatment. Based upon this study, it is concluded that displaced fractures of both forearm bones in children are preferred to be intramedullary fixed with K-wires when surgery is indicated with excellent and good results.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Fixation of Fractures of Forearm Bones in Children

Ameen¹,

Abdulrahman²,

Megahed³

et al. 2019

Zagazig University Medical Journal

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“…Pediatric patients, on the other hand, are often challenging in terms of ulnar fracture treatment. Recently, there is a growing inclination toward surgical management even in these cases, aiming for the most correct anatomic realignment [ 3 – 5 , 14 ]. However, there is always the possibility of complications and this is especially true in pediatric patients who have received poor or wrong care.…”

Section: Introductionmentioning

confidence: 99%

Vascularized fibular flap and custom-made synthesis in post-traumatic ulnar diaphyseal pseudarthrosis: a case report

Zanotti,

Molteni,

Lavagnolo

et al. 2023

J Med Case Reports

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Background Although isolated fractures of the ulnar shaft are considered common and relatively benign injuries, numerous complications can arise especially in the context of suboptimal care pathways. For pediatric patients, however, there is no single indication of the surgical approach. In the context of the management of these complications, it is known that the vascularized fibular graft has numerous advantages and indications in the treatment of recurrent pseudarthrosis. However, in revision surgery the frequent occurrence of anatomical subversions requires the use of fixation means adapted to the individual patient. We present a clinical case of an adult patient suffering from post-traumatic ulnar pseudarthrosis treated with autologous vascularized fibula grafts and 3D-planned custom-made plate. Case presentation A 38-year-old Ivorian woman came to our attention with a painful nonunion of the ulnar shaft and significant dysmorphism of the left forearm, with shortening and flexion of the limb as an outcome of unspecified road trauma in childhood. No alterations of the nerve compartment were reported. As far as detectable, she had undergone autologous bone grafting and implantation of questionable synthetic means, without acute treatment. Since we evaluated the patient (2012), we have performed two debridement surgeries, associated with autologous avascular bone graft from the iliac crest and plate fixation (2012 and 2014). In both cases, rupture of the fixation media was observed. In 2021, the pseudarthrosis was treated with a vascularized fibular bone graft. The subverted radius and ulna anatomy and poor bone quality required patient-specific reconstruction of the pseudarthrosic ulna from a 3D scan and the production of custom-made plate and screws, supported by the creation of special guides for drilling and by optimizing the positioning of screws with preoperative digital models. In the postoperative period, regular follow-up visits with X-rays evaluations were performed at 1, 3 and 6 months after surgery. No inflammatory reactions or local rejection were found. The fibula graft healed at the proximal ulnar junction six months after the operation while it took eight months to heal at the distal junction. Functionally, we observed a pain reduction and a range-of-motion preservation. Conclusions The multiple failures of diaphyseal reconstruction with avascular bone grafts have forced the indication to the vascularized fibular flap. This case is a unique experience but we believe that the association between vascularized bone graft and the potential for customization through 3D planning represents a valid surgical potentiality in complex cases of post-traumatic reconstruction.

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