Treatment for Gunshot Fractures of Upper Extremity Long Bones with Nerve Injuries

Abstract

The treatment results of gunshot fractures with nerve trunk injuries of upper extremity bones were summarized for the period from 1995 to 2000. Thirty patients had the injury at the level of humeral segment, 15 patients — at the level of forearm and 4 patients were with injuries of the elbow joint. The debridement and extrafocal osteosynthesis with early, i.e. 4 weeks after trauma, surgical interventions on bone fragments and nerve trunks were performed. In anatomically safe nerve trunk, neurolysis and bone fragment compression using special device were carried out. In nerve injury, resection of bone fragment ends with following stable osteosynthesis and perineural suturing of nerve was performed. In fractures of forearm bones with large defect of nerve trunk the autografting of nerve was done. In early postoperative period complex drug therapy was prescribed. After fracture healing physiotherapy, massage and exercise therapy was started. Long-term results showed that 82% of patients had positive outcomes. Duration of treatment using suggested tactics was shorter in comparison with traditional multy-step method.