Functional cast bracing in the management of open forearm fractures: a preliminary report.

BACKGROUND

Management of any injury is expensive to the individual and the community. For this reason modification of methods of managing trauma very often is necessary in resource poor countries.

OBJECTIVE

To verify the effectiveness of metal hinge joints in prevention of contractures and ankylosis of the elbow joint in cast immobilisation of reduced open forearm fractures.

PATIENTS

20 patients who had sideswipe injuries were managed from the year 01/01/2000 to date (20/5/2004) by the orthopaedic unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. They were referred from General Hospitals and Rural/Primary Health centers in northwestern Nigeria. They were all males, between the third and fourth decades of life (mean age was 35.54+1.52years).

METHODS

Management of these patients involved early anti tetanus prophylaxis, good wound hygiene, internal fixation of the reduced fractures with kirschner wires, cast immobilisation and incorporation of metal hinge joints at the elbow joint. Three days after surgery the casts were windowed and patients were discharged to continue wound dressing at the nearest Health Centres. The metal hinge joints permitted elbow joint movement throughout the period of immobilization. After 12.45+0.42 weeks (mean length of time of wound healing in these cases) casts and implants were removed.

RESULTS

Active movement of the elbows was rated as very good (8 cases), good (6 cases) and fair (6 cases). Plain radiography of the forearms showed fifteen cases of union and five cases of nonunion of fractures.

CONCLUSIONS

The outcome of treatment of these injuries discerns the effectiveness of functional cast bracing in the prevention of contractures and ankylosis of the elbow joint in cast immobilization of reduced open forearm fractures. The healed wounds made the skin safer for further management of the cases of nonunion.