Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius
A 12 year old girl presented to the casualty 4 h following fall from tree. She had complaints of pain and swelling with lacerated wound over distal forearm. On examination, swelling, tenderness with deformity of distal forearm was present with dislocation of elbow with 2 × 1 cm long lacerated wound over anterior aspect of distal forearm. There was no neurovascular deficit except a rent in the muscles through which the bone was extruded. The child's mother brought 12 cm extruded and soiled segment of radius. It was diagnosed as open segmental fracture both bone forearm with extruded segment radius and dislocation of ipsilateral elbow []. The X-ray forearm with wrist and elbow – anteroposterior and lateral revealed absence of middle segment of radius with fracture both bone forearm and dislocation of ipsilateral elbow [].\nThe wound was debrided. We planned to reinsert the extruded bone after thorough cleaning and autoclaving. The extruded segment was properly cleaned and scrubbed thoroughly with brush, savlon, hydrogen peroxide, normal saline, and betadine. Mud was removed from the external surface and from within the marrow cavities. Medullary cavity was properly syringed in antiseptic solution. No soft tissue was attached to the extruded segment except a few irregular tags of periosteum. Wound was irrigated with gentamycin solution and debrided. The extruded middle segment of radius was autoclaved and later immersed in normal saline before reimplantation. Under general anesthesia, elbow was reduced and the extruded segment was put inside the gap through the lacerated wound. Skin was closed loosely. A well padded above elbow slab was applied. After 5 days, the wound was dry. Under general anesthesia, by proximal and distal incisions, one 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment and another 2.5-mm K-wire was passed in ulna. The wound was closed. The patient received antibiotics postoperatively for 6 weeks. Gradual physiotherapy was started.\nFollowup was done at 2 weeks, 6 weeks, 10 weeks, 4 months, 5 months, 6 months, and 10 months with above elbow cast for 3 months []. At 4 months, the graft radiologically appeared less dense but around 5½ months, the bone started reappearing. After 5 months, ulnar wire was removed. Elbow and wrist mobilization exercises were continued. At 10 months followup the whole length of radius was restored.\nPatient had no infection, with slight restriction of elbow movement, nearly full range of motion (ROM) at wrist.\nX-ray showed complete remodeling of the bones. The child was fit to use her hand for writing, eating, and other activities of daily living (ADL) at 10 months [].