King Fahd Hospital -Madina Munawrah-Orthopedic Surgery Department

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Crushed Upper Limb

with a Favorable result

This is a 58 years old an with history of HTN on med tt ,
RTA of 3.5 months duration ,
With severe crushed lt forearm and hand
Bones and soft tissues were crushed as  shown ,
Vascular status :

Only doppler signal was detected over ulnar artery only ,with delayed capillary refilling of all fingers

 

- ER management done 1 st , then a plan was put in management of this limb started with discussion of patient about possible outcome and probabilities including possibility of AMPUTATION ,


then our strategy was based on SURGICAL PRIORITIES ..
1- Maintaining the circulation of forearm and hand ,
2- Washing and debridement with maximum benefit and least manipulation ,
Then
3- Reconstruction of bone and soft tissues

 

 

SERIAL OF EVENTS in OR .....
- Gentle wash and cleaning
- painting and drapping
- Flexible rod insertion for CRIF of lt ulna ( the least comminuted and contaminated bone )
- CRIF of hand fractures with k wires ( accepted position with least manipulation )
- Complete METICULOUS DEBRIDEMENT for all
- ORIF of lt radius with minifragment screws , k wires then supported with ext.fix
- Take over by plastic surgeon to manage hand lacerations and forearm soft tissue coverage
POST OP

Good follow up and care by all the treating team with continuous discussion about plans of next steps
NOW THIS IS
Follow-up visit today 21 April 2015 ................

 

Here is the videos of post operative follow up:

    Download the video of 3.5 MONTHS POST OP

 

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