Clinical Analysis Of Gustilo Type Ⅲ Forearm Fracture Treated With Antibiotic Cemented Plate Combined With External Fixation

Objective : To discuss and analyse the clinical efficacy of applying external fixation combined with antibiotic cement plate in phase I treatment of Gustilo III forearm fracture and provide some empirical value for clinical treatment.Methods:Retrospective analysis of 23 patients treated with Gustilo III forearm fractures using antibiotic cemented plates combined with external fixation in phase I from January 2020 to January 2022,with complete follow-up data.The cause of injury was agricultural machinery strangulation;20 males and 3 females,mean age51.78±7.62 years;4 cases of type IIIa,13 cases of type IIIb and 6 cases of type IIIc according to Gustilo’s typology.All patients were treated at the first stage of emergency surgery with debridement and were fixed with an antibiotic cemented plate combined with an external fixation.The clinical data of 32 patients with Gustilo type III forearm fractures treated with a metal pin combined with an external fixation frame in phase I from January 2017 to January 2020 were also retrospectively analyzed as a control group.The cause of injury was agricultural machine strangulation in all 32 cases;28 of them were male and 4 were female,with a mean age of 50.13±7.37 years;among them,5 were type IIIa,19 were type IIIb and 8 were type IIIc according to Gustilo’s typology.The control group was fixed by first-stage emergency debridement and metal pins combined with external fixation repositioning.Follow-up visits were conducted at 1,2,4,6 and 12 months postoperatively for assessment.The items evaluated included the number of phase I debridement procedures,time to wound healing,length of hospital stay,time to decrease inflammatory factors,number of cases of superficial and deep infection and number of cases of osteomyelitis respectively;and the length of time to replace the metal internal fixation in phase II and bony healing.Results : The use of an antibiotic cemented plate combined with an external fixation in the first stage of treatment of Gustilo III forearm fractures has achieved more satisfactory clinical results.Compared to the treatment with metal pins alone,this procedure reduces the number of debridement procedures,promotes wound healing,accelerates the decline of inflammatory factors,speeds up the interval between metal plate replacement,promotes bony healing,reduces the length of hospital stay,and can reduce the financial and psychological burden on the patient.Conclusion : 1.The use of antibiotic cemented plates in Gustilo III forearm fractures can effectively control infection,reduce the number of debridements,promote wound healing and shorten the treatment period.2.The Masquelet membrane produced by antibiotic cemented plates can promote bony healing.