Keywords
Amputação
Osteossíntese
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To report a case of a patient with an open fracture of the elbow that was managed with definitive surgical treatment in the initial approach in a borderline scenario for possible amputation or external fixation to control local damage. Case details: Male, 36 years old, victim of a car accident. The patient had extensive soft tissue injury and bone, nerve and vascular exposure. A diagnosis of fracture of the elbow was made through X-rays, and definitive fixation of the fractures was carried out with plates and screws. Subsequently, follow-up was performed with additional procedures in order to perform treatment for post-traumatic residual stiffness. After 2 years of follow-up, the patient has achieved a largely functional outcome and is satisfied with the current outcome. Final considerations: The management of these complex cases remains a challenge for the medical community in general and, mainly, for orthopedic surgeons. In some cases, the first approach may be the only chance to save the patient's limb, even when the context is challenging. Therefore, we present a report where we demonstrate an acceptable result in this context in order to encourage surgeons to always consider this therapeutic option.
References
AGRAWAL A. Unified classification of open fractures: Based on Gustilo and OTA classification schemes, Injury, 2018; 49(8): 1526-1531.
AZAR FM, et al. Campbell’s Operative Orthopaedics. 13 ed., Philadelphia: Elsevier, 2017; 2657-2708p.
BARTOW-MCKENNEY C, et al. The microbiota of traumatic, open fracture wounds is associated with mechanism of injury. Wound Repair Regen, 2018; 26(2): 127-135.
BANO C, et al. Management of open elbow fractures: experiences and outcomes from a UK major trauma center. J Shoulder Elbow Surg. 2022; 31(3): 461-468.
BELANGERO WD, et al. Fraturas expostas isoladas da diáfise da tíbia: estudo prospectivo observacional em sete hospitais de dois países da América Latina. Rev Col Bras Cir. 2022; 49: e20223301.
BRITISH ORTHOPAEDIC ASSOCIATION TRAUMA COMMITTEE. British Orthopaedic Association Standard for Trauma (BOAST): Open fracture management. Injury, 2020; 51(2): 174-177.
DIWAN A, et al. The principles and practice of open fracture care. Chinese Journal of Traumatology. 2018; 21(4): 187-192.
GARNER MR, et al. Evaluation of the orthopaedic trauma association open fracture classification (OTA-OFC) as an outcome prediction tool in open tibial shaft fractures. Archives of orthopaedic and trauma surgery. 2022; 142(12): 3599–3603.
GIGLIO PN, et al. Avanços no Tratamento das Fraturas Expostas. Rev Bras Ortop., 2015; 50(2): 125-30.
GUSTILO RB e ANDERSON JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. The Journal of Bone & Joint Surgery. 1976; 58(4): 453-458.
HEBERT S, et al. Ortopedia e Traumatologia: Princípios e Prática. 5 ed.Porto Alegre: Artmed, 2017; 1530p.
HEITZMANN LG, et al. Osteomielite crônica pós-operatória nos ossos longos – O que sabemos e como conduzir esse problema? Revista Brasileira de Ortopedia. 2018.
LUDY DW. Revisiting the Classic Open Fracture Studies to Correct Misperceptions and Errors. The Journal of the American Academy of Orthopaedic Surgeons. 2022; 30(18), e1148–e1151.
MEINBERG E, et al. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma, Wolters Kluwer, 2018; 32(1): 3-170.
PACCOLA CA. Fraturas expostas. Rev Bras Ortop., 2001; 36(8).
PAULO GML, et al. Trauma: característica sociodemográficas das vítimas e aspectos clínicos-assistenciais de sua ocorrência em hospital de urgência. Revista Eletrônica Acervo Saúde, 2021; 13(10): e8683.
PNG ME, et al. Association between the Orthopaedic Trauma Society classification of open fractures and economic costs. Bone Joint J., 2022; 104-B(3): 408-412.
POZZI I, et. al. Manual de trauma ortopédico / SBOT - Sociedade Brasileira de Ortopedia e Traumatologia. São Paulo: SBOT - Sociedade Brasileira de Ortopedia e Traumatologia, 2011; 34p.
OLIVEIRA RV, et al. Análise comparativa da acurácia das classificações de Gustilo e Tscherne como preditoras de infecção em fraturas expostas. Revista Brasileira de Ortopedia. 2018.
SAGI HC, et al. Evolution in the Acute Management of Open Fracture Treatment? Part 1. Journal of Orthopaedic Trauma, 2021; 35(9): 449-456.
SAMAI K e VILELLA A. Update in Therapeutics: Prophylactic Antibiotics in Open Fractures. Journal of trauma nursing, 2018; 25(2): 83–86.
SUDDUTH JD, et al. Incidence and quality of care for open fractures in England between 2008 and 2019 a cohort study using data collected by the Trauma Audit and Research Network. Bone Joint J., 2022; 104-B(6): 736-746.
TORNETTA, III P, et. al. Rockwood and Green's fractures in adults. 9 ed. Philadelphia: Wolters Kluwer, 2020; 727-736p.
YIM GH e HARDWICKE JT. The Evolution and Interpretation of the Gustilo and Anderson Classification. The Journal of bone and joint surgery, 2018; 100(24): e152.