Management of civilian gunshot limb injuries: A comparison of Early Total Care and Damage Control Orthopedics.

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Abstract

Conflict of interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 4. Injury. 2023 Dec;54(12):109183. doi: 10.1016/j.injury.2020.11.021. Epub 2020 Nov 17. Wrist arthroplasty for treatment of infected distal radius nonunion using free vascularised proximal fibular bone graft. Noaman H(1), Sorour Y(2), Marzouk A(3). Author information: (1)Hand and Microsurgery Unit, Faculty of medicine, Sohag University, Sohag, Egypt. Electronic address: hassan_h@mailcity.com. (2)Lecturer of Orthopedics and Hand surgery, Faculty of medicine, Sohag University, Sohag, Egypt. (3)Lecturer of Orthopedics and Traumatology, Faculty of medicine, Sohag University, Sohag, Egypt. OBJECTIVE: Management of infected distal radius nonunion with a bone defect and radiocarpal and distal radio-ulnar joint arthritis is considered an orthopaedic challenge. Although several methods have been described but none provide a satisfactory solution. Free vascularised fibula bone graft constitutes a good option to eradicate the infection, correct the deformity, compensate for the shortening and maintain motion. MATERIAL AND METHODS: This study included 15 cases with infected distal radius nonunion associated with bone defects. Nine cases were males and six were females. The average age of the patient was 20 years (range 8 - 60 years). The right wrist was involved in 10 patients and left was affected in 5 patients. Nine cases resulted from a motor vehicle accident, four cases after a firearm injury and two cases due to falling from a height. The average number of previous surgical procedures was three (range 2 -6). The principle of treatment was debridement, excision of distal radius and trimming of the proximal part of radius back to healthy bleeding bone, inserting the free vascularised proximal fibular bone graft to compensate the defect and fixation of the graft. RESULTS: The procedure was successful in 13 of 15 cases. Bone union was achieved at an average of 4 months. No clinical evidence of osteomyelitis or or infection at final follow-up. Pain was completely relieved in all cases. Wrist joint range of motion averaged flexion 50˚, extension 45˚ and handgrip was the same as the normal site. Twelve cases out of 15 returned to their daily activities. CONCLUSION: Free vascularised proximal fibula bone graft is a new indication for the treatment of an infected distal radius nonunion with a bone defect. Copyright © 2020. Published by Elsevier Ltd. DOI: 10.1016/j.injury.2020.11.021