Guest Professor David Nelson Case 2

It was felt that this case was a Grade II open fracture, but that the indications for ORIF in Grade II open fractures of the upper extremity are quite different from those in the lower extremity and that immediate ORIF was indicated (Chapman, JBJS, 1989). We were prepared for both external fixation as well as internal fixation. Our preference was a fixed-angle volar plate.

The patient was given IV antibiotics in the ED. She was taken to the OR within 4 hours of her fall (about 1 hour after her arrival in the ED), where she was given a general anesthesia. Prior to being prepped and draped, she had a pulse lavage of 3 liters and debridement with currettes. Then she was prepped and draped and had a second pulse lavage with debridement. After the second lavage, her fractures were reduced. This exposed new areas of the wounds for inspection and debridement, so a third pulsed lavage and debridement was performed.

It was felt that the wounds were not excessively contaminated, our debriedment was fairly effective, and the decision was made to do an ORIF. The amount of distal bone seemed quite adequate to allow a volar plate, so a fixed-angle plate was placed.

A fouth irrigation was performed at the conclusion of the fixation. The incisions were closed and the open wounds loosely closed. She was placed on IV Kefzol and Gentamycin. No cultures were taken.

(4) What would you do for the ulna? Does it need treatment? Would a K-wire suffice?