Open Forearm Fracture – Part 1

Civilian injuries are always difficult, especially when they involve children.  In this case study, a 15-year-old boy, Farhad M., sustained a gunshot wound to his right forearm from an AK47 when he got caught in some crossfire. Fortunately, the boy sustained no other injuries.

Upon examination at a field hospital, Farhad M. was found to be neurologically and vascularly intact; radiographs showed a comminuted radius fracture and an intact ulna. He was taken to the OR for debridement and his wounds were left open and splinted.

Five days later, Farhad M. returned to the OR for delayed primary closure.  The surgeons debated whether or not to use closed management, external fixation, intramedullary fixation, or internal fixation in this austere environment.

What would be your next step as the treating surgeon? Check back to learn how the surgeon proceeded in this austere environment.