This chapter discusses clinical approaches to addressing traumatic bone defects in the forearm, which can result from various causes, including traumatic injuries, neoplastic lesions, infection, or nonunion of forearm fractures. Such defects can significantly impact a patient’s quality of life and functional capabilities. The article emphasizes the importance of timely and comprehensive management. In cases of severe injuries that compromise the vascularity of the soft tissues around the bone, a two-session approach is recommended. The first session focuses on enhancing the nutritional capacity of the surrounding soft tissues through procedures such as debridement, vacuum therapy, detection of causative microorganisms, antibiotic treatment, and the use of muscle flaps to improve blood supply. The second session aims to achieve stability and functionality through avascular and/or vascular bone grafts. Autogenous bone grafts, particularly from the iliac crest, remain a reliable method for addressing segmental bone loss due to their mechanical stability, the ability to fill inter-fractural spaces, and support for healing. Cortical bone grafts offer osteoconductive benefits, while cancellous autografts provide osteoconductive, osteoinductive, and osteogenic functions. Dual bone grafts or tibial bone slabs are recommended for preventing late graft fractures in large bones like the humerus, femur, and tibia. The fixation of adult forearm fractures with open reduction and compression plates has been widely practiced, offering early motion and anatomical integrity preservation. Complications of fixation can include infection, malunion, nonunion, nerve injury, compartment syndrome, bleeding, synostosis, and limited movement. Complex injuries involving significant damage to bone, muscle, skin, tendons, and neurovascular structures require prompt emergency management, thorough examination, vascular evaluation, and antibiotic therapy to prevent infection. High-energy injuries pose a higher risk of infection in the lower extremities compared to the upper extremities due to differences in soft tissue thickness and blood circulation. Overall, well-prepared and planned reconstruction efforts, guided by a trauma team well-versed in orthopedic and plastic surgery principles, can provide patients with stable, functional extremities. Microsurgical methods can expedite bone union, and early primary and secondary healing of bone and soft tissues can minimize the risk of infection and nonunion, enabling early rehabilitation and a quicker return to daily activities.

Reconstruction of the Forearm Traumatic Defects

章节
发表日期：

2025年

查看全文

Yalın Dirik,
Ajlan Kasabalıgil,
Tolga Türker,
Mehmet Alp

摘要

This chapter discusses clinical approaches to addressing traumatic bone defects in the forearm, which can result from various causes, including traumatic injuries, neoplastic lesions, infection, or nonunion of forearm fractures. Such defects can significantly impact a patient’s quality of life and functional capabilities. The article emphasizes the importance of timely and comprehensive management. In cases of severe injuries that compromise the vascularity of the soft tissues around the bone, a two-session approach is recommended. The first session focuses on enhancing the nutritional capacity of the surrounding soft tissues through procedures such as debridement, vacuum therapy, detection of causative microorganisms, antibiotic treatment, and the use of muscle flaps to improve blood supply. The second session aims to achieve stability and functionality through avascular and/or vascular bone grafts. Autogenous bone grafts, particularly from the iliac crest, remain a reliable method for addressing segmental bone loss due to their mechanical stability, the ability to fill inter-fractural spaces, and support for healing. Cortical bone grafts offer osteoconductive benefits, while cancellous autografts provide osteoconductive, osteoinductive, and osteogenic functions. Dual bone grafts or tibial bone slabs are recommended for preventing late graft fractures in large bones like the humerus, femur, and tibia. The fixation of adult forearm fractures with open reduction and compression plates has been widely practiced, offering early motion and anatomical integrity preservation. Complications of fixation can include infection, malunion, nonunion, nerve injury, compartment syndrome, bleeding, synostosis, and limited movement. Complex injuries involving significant damage to bone, muscle, skin, tendons, and neurovascular structures require prompt emergency management, thorough examination, vascular evaluation, and antibiotic therapy to prevent infection. High-energy injuries pose a higher risk of infection in the lower extremities compared to the upper extremities due to differences in soft tissue thickness and blood circulation. Overall, well-prepared and planned reconstruction efforts, guided by a trauma team well-versed in orthopedic and plastic surgery principles, can provide patients with stable, functional extremities. Microsurgical methods can expedite bone union, and early primary and secondary healing of bone and soft tissues can minimize the risk of infection and nonunion, enabling early rehabilitation and a quicker return to daily activities.