Ablation of Distal Ulna as an Index Procedure in A Complex Open Distal Radius-Ulna Fracture with Defective Soft Tissue Coverage
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 4
Abstract
Unstable open fracture of the distal ulna with severe soft tissue disruption in association with distal end radius fracture may be beyond the scope of fixation. There is little scientific support to guide the management of this devastating fracture. We opted to perform a distal ulna resection in a young patient at the time of definitive rigid fixation of the distal radius and successfully managed to close the wound primarily. This technique has provided a reproducibly satisfactory reconstruction and maintenance of reasonably near normal wrist joint biomechanics.Open comminuted intra-articular fractures of the distal ulna with significant skin defect associated with fractures of the distal radius is rare. This prevailing fracture with concomitant destabilizing injury to the primary and secondary radio-ulnar ligamentous structures is invariably associated with distal radio-ulna joint instability. Anatomic fragment reduction and stable retention of the distal ulna may not be feasible by osteosynthesis. Extensive zone of injury at the wrist and forearm oppresses durable and viable soft tissue coverage. There is minimal guidance in the current literature regarding management of this difficult fractures. This case report describes the pivotal role of distal ulna resection in irreparable unstable fractures with soft tissue inadequacy.A 33-year-old male nurse who was involved in a road traffic accident had sustained a distal end left radius fracture AO 2.3-C1; and open comminuted fracture of the distal left ulna Biyani classification Type IV [1] with distal radio-ulnar joint instability as well as a contaminated wound measuring 2.5 x 1.5cm. The exposed ulna head was devoid of periosteum. The right hand dominant motorcyclist also acquired a radial head fracture Mason type 1 and fracture base of 5th metacarpal bone of the ipsilateral left upper extremity.. An urgent thorough osseous and soft tissue debridement was performed under general anesthesia in the emergency theatre. The distal radius was approached via the modified Henry’s, reduced and temporarily fixed with 2 cross k-wires and augmented with a spanning external fixator across the wrist. The distal ulna was approached dorsally incorporating the traumatic wound. Dorsal cutaneous branch of the ulna nerve was identified and preserved (Figure 1). The extensor retinaculum and distal radio-ulnar joint capsule was gravely damaged.The comminuted fragments of the distal ulna were reduced and temporarily fixed with multiple intrafocal pinning. Reduction of the ulna head into the sigmoid notch was laborious and recalcitrantly dislocated dorsally. The size of the wound after debridement had increased to 3.0 x 4.5cm exposing the underlying extensor carpi ulnaris (ECU) and extensor digiti quinti proprius (EDQP), their sheaths and the distal ulna. Closed reduction and percutaneous pinning of the base of the 5th metacarpal was done. The radial head was managed conservatively. The forearm was immobilized in a sugar thong slab. Intravenous cefuroxime and gentamycin were administered. Despite regular hydrogel dressing of the wound, the exposed ulna was dry and mildly necrotic. Definitive stable fixation of the radius via a variable angle locking plate was subsequently performed. The distal ulna was approached from the previous wound dorsally.
Authors and Affiliations
Rudy Reza Johan, Tan Jin Aun, Juzaily Fekry Leong
Keywords
Related Articles
- EP ID EP598332
- DOI 10.26717/BJSTR.2019.13.002439
- Views 159
- Downloads 0
Time-Dependent Bactericidal Efficacy of Hydrogen Peroxide against Methicillin-Resistant Staphylococcus Aureus and Acinetobacter Baumannii in Second Degree Burn Wound
Nosocomial infections are major health care problem and their developing antibiotics resistance have made it harder to treat. Hydrogen peroxide (H2O2) is widely used for contaminated wound sterilization, but its efficacy...
Development of A Novel Ultrasonic Sound-Generated Device: The Physical Tool for Controlling Immature Stages of Mosquitoes Transmitting Dengue Haemorrhagic Fever (Aedes aegypti) and Filariasis (Culex quinquefasciatus)
Perseus is an ultrasonic sound-generated device developed as a physical tool for controlling the immature stages of mosquitoes by generating an ultrasonic wave at an appropriate frequency, which is specific to mosquito l...
In the Guidelines for Physicians and Urologists "Watchful Waiting" for Benign Prostatic Hyperplasia (BPH) should be Replaced with Thermobalancing Therapy that Treats Prostate Effectively, Cost-Effectively and Safely
Primary care physician is the first contact for screening for benign prostatic hyperplasia (BPH), conducting timely diagnostic work, and initiating relevant therapy. To protect men with lower urinary tract symptoms (LUTS...
Patterns of Cataract in Patients Reporting to Christian Hospital, Taxila, Pakistan
Introduction: Cataract is cause of blindness in about 5% of the population in America and twenty million throughout the world. There are many reasons behind it and they can be controlled at the early age to prevent blind...
Serum albumin conformation in patients with melancholic depression under antidepressant therapy
Discovery of biomarkers of mental disorders for evaluation of efficacy of psychopharmacotherapy is an important task. The last years it became clear that disturbances in molecular processes in pathological condi...