Posted: Aug 24 2019 #(C101255) 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope

Open Both Bone Forearm Fracture in a 44F

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HPI

Patient presented to the ED with chief complaint of left forearm pain following a bicycle accident. Patient denies additional injuries. Patient denied motor or sensory deficit.

PMH

HTN, GERD History of breast reduction surgery Denied alcohol, tobacco, or illicit substance use

Patient is alert and oriented in the ED with pain to palpation of the left forearm. She has a 1cm x 1cm open wound over the ulna. She is neurovascularly intact. Remainder of the exam is unremarkable

Poll

1 of 10

1. According to the Gustilo classification, how would you classify this open fracture?

Type I

41%

853/2075

Type II

27%

577/2075

Type III

104/2075

Type IIIa

20%

418/2075

Type IIIb

84/2075

Type IIIc

39/2075

2. What antibiotics would you put this patient on for the open fracture?

Ancef alone

58%

1180/2014

Ancef + Vancomycin

113/2014

Ancef + Gentamicin

28%

583/2014

Ancef + Penicillin

77/2014

Vancomycin alone

17/2014

Other

44/2014

3. In addition to I&D, how would you treat this fracture?

ORIF without bone grafting

81%

1614/1987

ORIF with bone grafting

126/1987

External Fixation

151/1987

IM Nailing

93/1987

Functional bracing

3/1987

4. Considering the open wound over the ulnar, when performing ORIF would you perform fixation of the ulnar or radius first?

Ulna

60%

1163/1927

Radius

38%

742/1927

I would not perform ORIF

22/1927

5. If performing ORIF, what surgical approach(s) would you use to address this injury?

Single Volar (Henry) approach for both Ulna and Radius

101/1799

Single Dorsal (Thompson) approach for both Ulna and Radius

63/1799

Volar (Henry) approach for Radius, separate incision for Ulna (over Ulna, between ECU and FCU)

74%

1345/1799

Dorsal (Thompson) approach for radius, separate incision for Ulna (over Ulna, between ECU and FCU)

14%

268/1799

I would not perform ORIF

22/1799

6. What type of fixation you use to address the segmental radial shaft Fx?

Single plate

57%

1022/1786

Combination of mini fragment plates and a long plate to span both segments

22%

395/1786

Two separate plates to address each segment

14%

251/1786

Intramedullary rod

109/1786

Other

9/1786

7. What type of plate fixation would you use for the Ulna Fx?

Small frag dcp

48%

834/1719

2.7 mm dcp

26%

447/1719

Minifrag dcp

57/1719

Recon plate

150/1719

1/3 Semitubular plate

12%

209/1719

I would not plate the ulna

22/1719

8. If performing bone grafting, what would you use?

Cancellous Allograft Chips

12%

208/1680

Fibula Allograft

21/1680

Autogenous Cancellous Graft

18%

306/1680

Autogenous Vascularized Fibular Graft

16/1680

I would not perform bone grafting

67%

1129/1680

9. What is your post operative dressing?

Sugartong splint

37%

622/1679

Short arm splint

18%

317/1679

Soft dressing

22%

382/1679

Cast

13%

233/1679

Forearm brace

125/1679

10. What is your immediate range of motion and weight bearing protocol post-operatively?

ROM as tolerated, WBAT

11%

187/1633

ROM as tolerated, NWB

46%

759/1633

Protected ROM, WBAT

157/1633

Protected ROM, NWB

32%

530/1633

Intra-procedure P1

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