Hybrid external fixation in high-energy elbow fractures: A modular system with a promising future

Background: Severe, high-energy; periarticular elbow injuries producing a " floating joint" are a major surgical challenge, Their reconstruction and re habilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds. Methods: Seven adults with compound open peri- and intra-articular elbow fr actures were treated in hybrid ring tubular fixation frames. After debridem ent, bone stabilization, and neurovascular reconstructions, early controlle d daily movements were started in the affected joint. Results: These seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfa yan functional score were excellent in two, good in one, and fair in four o f these severely mangled upper extremities. None was amputated. Conclusions: The Mangled Extremity Severity Score has been shown to be unab le to provide a reliable assessment for severe high-energy limb injuries su rgically managed with the modular hybrid thin wire tubular external fixatio n system. This hybrid system is a very useful addition to the surgical arma mentarium of orthopedic trauma surgeons, It both allows complex surgical re constructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation s ystem is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of th e elbow joint (floating elbow) with severe damage to soft tissues, This fix ation system allows individual Fixation of forearm bone fractures, thus all owing the preservation of pronation-supination movements.