Freeland A E, Jabaley M E
Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson.
Hand Clin. 1988 Aug;4(3):425-36.
Open type III fractures of the hand or wrist with severe bone and soft tissue loss justify aggressive treatment to restore anatomy, assure healing, and maximize functional recovery. The techniques of modern wound excision used at initial surgery predictably result in a decompressed and surgically clean wound within a few days from injury in the vast majority of cases. This allows a safe application of delayed primary internal fixation and bone grafting for fracture restoration or joint arthrodesis as well as early wound closure or coverage. The immediate or early application of stable external devices, internal fixation, or combinations of the two along with early bone grafting restores the structural integrity of the skeleton, reduces pain, protects other repaired and reconstructed tissues, promotes the healing, and supports early and intensive functional rehabilitation of the hand and wrist. Early wound closure or coverage minimizes scar formation. Together, the early sequencing of effective wound debridement with skeletal stabilization and bone grafting and early wound closure or coverage provide the most favorable circumstances for healing and functional recovery of the seriously damaged hand and wrist.
伴有严重骨与软组织缺损的开放性手部或腕部Ⅲ型骨折，需要积极治疗以恢复解剖结构、确保愈合并最大程度地促进功能恢复。在绝大多数情况下，初次手术时采用的现代伤口清创技术可在受伤后数天内使伤口减压并实现手术清洁。这使得能够安全地延迟进行一期内固定和植骨以修复骨折或进行关节融合，以及早期闭合伤口或覆盖创面。立即或早期应用稳定的外固定装置、内固定或两者结合，并早期植骨，可恢复骨骼的结构完整性，减轻疼痛，保护其他修复和重建的组织，促进愈合，并支持手部和腕部的早期强化功能康复。早期闭合伤口或覆盖创面可最大程度减少瘢痕形成。有效的伤口清创、骨骼稳定和植骨以及早期伤口闭合或覆盖的早期有序进行，共同为严重受损的手部和腕部的愈合和功能恢复提供了最有利的条件。
