Free Fibula and Corticocancellous Bone Grafting for Salvage of a War-injured Forearm

• Published in: Journal of orthopaedic trauma Vol. 20; no. 7; pp. 495 - 498
• Main Authors: Manojlovic, Radovan D, Vuckovic, Cedo, Tabakovic, Dejan, Nikola, Gavric, Bumbasirevic, Marko
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-07-2006; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Diseases of the osteoarticular system; Fibula - transplantation; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Radius - transplantation; Radius Fractures - surgery; Salvage Therapy; Traumas. Diseases due to physical agents; Ulna Fractures - surgery; Warfare; Radius; Ulna; Fibula; Motor system disorder; Bone graft; Diseases of the osteoarticular system; War; Fracture; free fibula; Wound; Diaphysis; Forearm; Surgery; Blood vessel; Mine; Median nerve; Neurological disorder; Cicatrization; Human; Nervous system diseases; war injury; Cubital nerve; cancellous grafting; Intramedullary wire; Trauma; Fixation; Treatment; Surgical amputation; Debridment; External; Soft tissue; Lesion; Bone; Radioulnar joint
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/00005131-200608000-00008

The treatment of a complex forearm injury inflicted by a wartime mine explosion is presented in this study. Apart from the soft tissue damage, a 4-part fracture of the radius and loss of 19 cm of the ulnar diaphysis were present along with lesions of the median and ulnar nerves. The radial pulse was intact. The first formal treatment of the wounding consisted of extensive soft tissue and bone debridement and external fixation of radius with an additional intramedullary K-wire. After wound closure was obtained, a free vascular fibula grafting of the ulna and corticocancellous bone grafting of the radius were performed. Bone union of both the radius and ulna was subsequently achieved and 9 years after the injury, the patient has full flexion and extension of the elbow, full pronation and 70% of supination. Motion of the wrist is limited because of an ulnar plus variant of the distal radioulnar joint. Hand function is still limited by chronic low-moderate median nerve palsy, but the ulnar nerve has recovered completely. The patient is able to pinch, has full finger extension and can make a fist. He is satisfied that he made the correct decision in not having an initial amputation for his injury.