Isolated ulnar shaft fractures treated with functional braces.

OBJECTIVE: To report the results from functional bracing of isolated ulnar shaft fractures. DESIGN: Retrospective review. SETTING: Two university hospitals. PATIENTS: Isolated ulnar shaft fractures in 444 patients were stabilized in functional braces that permitted full range of motion of all joints. INTERVENTION: Prefabricated braces that extended from below the elbow to above the wrist were applied within the first week after the initial injury. OUTCOME MEASURES: Union of the fracture, fracture angulation, and final range of motion of the forearm were evaluated. RESULTS: Two hundred eighty-seven patients were available for follow-up (65 percent). Union took place in 99 percent of the fractures. Shortening of the ulna averaged 1.1 millimeters (range 0 to 10 millimeters). Final radial angulation averaged 5 degrees (range 0 to 18 degrees). Dorsal angulation averaged 5 degrees (range 0 to 20 degrees). Average loss of pronation was greatest in fractures of the proximal third of the ulna, averaging 12 degrees. Fractures in the distal third averaged a loss of 5 degrees of pronation. CONCLUSIONS: Functional bracing is a viable therapeutic alternative in the management of isolated ulnar shaft fractures. It is associated with a 99 percent union rate and good to excellent functional results in more than 96 percent of patients.

Assessment of soft tissue injury in open tibial shaft fractures by transcutaneous oximetry.

Transcutaneous oximetry was performed on 32 patients with 33 open tibial shaft fractures in an attempt to identify those patients at risk for the subsequent development of serious complications. Oxygen electrodes were placed on areas of intact skin, over viable compartments at the fracture site (wound) as well as on the anterior chest wall (control). Simultaneous wound and chest wall measurements were obtained after equilibration (30 minutes) on both room air and 100% oxygen. Values obtained were expressed as absolute values and as percentages of the wound measurement divided by the chest measurement. The study group consisted of 27 male and five female patients with an average age of 37 years (range, 17-63 years). There were 8 Grade I, 12 Grade II, and 13 Grade III fractures as described by Gustilo et al. Complications requiring medical or surgical intervention occurred in six patients: four deep infections, one deep vein thrombosis, and one superficial infection with severe bone and soft tissue loss requiring multiple procedures. Transcutaneous oximetry with patients breathing 100% oxygen was found to correlate with the development of complications in this study group. Five (42%) of 12 patients with transcutaneous oximetry values < or = 85 mm Hg and a wound-to-chest ratio < or = 25% developed a complication, whereas only one of 19 patients with either a fracture site value greater than 85 mm Hg or a wound to chest ratio greater than 25% developed a complication (p = 0.007).