Mangled Upper Extremity Salvaged with Spatial Frame, Skin Grafts, Wrist Fusion and Transfer of FCR to EDC

An 18 year old male sustained a mangled upper extremity after a motor vehicle collision. The injuries to his forearm included open fractures with bone loss to the radius and ulna, two areas of full-thickness dermal loss, and irreparable damage to all extensor tendons except to the thumb. A large area of skin degloving was present circumferentially. All arterial flow through the forearm and into the hand was intact on an angiographic study. The ulnar nerve had a segmental defect in the mid-forearm of 4 centimeters (cm). Treatment consisted of three debridements in the first 5 days followed by wound closure and skin grafting. For 6 weeks, no attempt was made to stabilize the fractures with either internal or external fixation. Infection risk was deemed to be too high. A Taylor spatial frame (TSF) corrected the forearm alignment over a course of 8 weeks. Open reduction and internal fixation of the radius and wrist fusion was performed with a long 18-hole plate. Transfer of flexor carpi radialis to the finger extensors was the final part of the procedure at the time of fixation. The patient has returned to school, and he has regained functional use of his hand.