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Outcomes of Surgical Treatment for High Energy Open Forearm Fractures
Jonathan Seavey, MD1; Elizabeth M. Polfer, MD1; Benjamin W. Hoyt, BS2; George C. Balazs, MD1; Derek F. Ipsen, DO1; George P. Nanos, MD1; Scott M. Tintle, MD1
1Walter Reed National Military Medical Center, Bethesda, MD; 2Uniformed Services University of the Health Sciences, Bethesda, MD

Introduction: We hypothesized that open forearm fractures in the military population are primarily high-energy injuries with high rates of complications, but have high rates of union after surgical treatment. ?

Methods: The surgical records of all patients surgically treated for open radius/ulna fractures between January 2006 Ž- January 2014 at a single military facility were reviewed. Primary outcome was bony status of the injured extremity (union, nonŽunion, amputation) following definitive treatment. Secondary outcomes included rate and severity of heterotopic ossification and radioulnar synostosis.

Results: A total of 66 patients with open fractures were reviewed (7 isolated radius fractures, 39 isolated ulna fractures, and 20 bothŽbone fractures). Average patient age was 25.2 years, and the average BMI of patients treated was 25.4. Most fractures were comminuted (78.7%) and resulted from blast injuries (79.4%). An ipsilateral vascular injury was present in 30.3%. A total of 62 patients underwent definitive treatment with open reduction internal fixation (93.9%), 2 with intramedullary nailing (3%), one with elbow fusion (1.5%), and one required early amputation (1.5%). Soft tissue coverage required skin grafting in 28 patients (42.4%) and flap coverage in 26 patients (39.4%). Union was achieved in 83.8% of patients after primary treatment. Of the remaining nine patients, one required amputation after ORIF due to massive radial and ulnar artery thrombosis, and eight developed nonŽunions. Six of the nonŽunions healed after late bone grafting, one passed away prior to nonŽunion surgery, and one refused further intervention. The final union rate in this series was 93.9%. Complication rates were high, with heterotopic ossification developing in 21 patients (54.5%), and a radioulnar synostosis developing in eight patients (12.1%). Bone loss at the fracture site was a significant risk factor for development of a nonŽunion after initial treatment (p=0.01). ?

Conclusion: This cohort of high-energy open forearm fractures had a substantially lower union rate relative to previously published series. Complication rates were high, and bone loss at the fracture site predicted later nonŽunion.

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