Aim of Study: The clinical and radiological assessment of the results of the operative treatment of fractures of the upper limb with associated soft tissue involvement. Methods: We present a review of 17 patients with fractures, nonunions, pseudarthroses and malunions of the forearm (8) and hand (9) with associated soft tissue involvement. All cases were chronic injuries. Three female and 14 male with average age of 27 (12–43) were operated between 9/1998 and 3/2002. The average time before surgery was 10 months. The causes of the defects were severe trauma in 10 cases, electric injuries in 2, osteomyelitis in 3 and combustion in 2 cases. At follow-up the patients were evaluated for bone unuon, ßap integration, function (AROM, grafting power), complications. In 13 patients we performed an open reduction and internal þxation (ORIF) with Pi-, LC DCP, T-plates; in 4 Ð an external þxation (AO-þxator). The osteosynthesis was accompanied with free ßaps transfer (2), pedicled ßaps (8), free nonvascularized bone grafts (3), local skin ßaps and skin grafting (7). Results: The good and excellent results (bone union, ßap integration) were received in 78% of patients, who we performed the transposition of the pedicled ßaps, in a combination with stabile þxation (ORIF); satisfactory Ð in 22%. We observed the following complications: partial necrosis of ßap (3), and bone graft (2), refracture (1). Conclusions: The combination of stabile þxation of bone fragments and adequate coverage of the soft tissue defects is an efþcient method in the treatment of bone fractures with soft tissue involvement. This combination creates an optimal condition for early rehabilitation and improves results of treatment.

Introduction Distal radius fractures are the most common in the upper extremities and usually comminuted and unstable. The following techniques are usually used in treating these fractures: osteosynthesis with plates and screws (ORIF), Ilizarov device and the AO- external fixator, K – wires.

The main aim of the report is to study the results of surgical treatment of distal radius nonunion, malunion, and pseudarthrosis in cases when different techniques of fixation were used.

Material and methods. In 1998–2001 a clinical study of 48 patients (33 males and 15 females) with distal radius injury was conducted in orthopedics department. The mean age of the patients was 42 years (15–69). 28 patients had the injury of their right hand and 20 - of their left hand. 19 patients had distal radius non-union, 15 – malunion, and 14 – pseudarthrosis. The average time from injury to the surgical treatment was 5 months. The mean follow-up was 27,2 Months (12–36). The AO techniques (ORIF with titanium and stainless steel implants) were used in Group I (36 patients). Conventional techniques and fixators were used in 13 patients of Group II: home produced plates and screws, Ilizarov device, external fixator, K- wires. The indications for surgical treatment nonunion were: A3 type, B1 – B3 type, C1 – C3 type, accompanied by more than two criteria of instability. In 10 patients with extraar-ticular fractures we used osteosynthesis with dorsal or palmar T-plates (3.5 mm). Mini-«T» - and «Pi»-Plates (2,7 mm) were used in four patients who had comminuted fractures with tiny distal fragments (‘bursting’ mechanism).The Ilizarov device and K-wires were used in five patients. Radius reduction without rotational and angular deformity was considered to be an indication for shortening osteotomy of the ulna. Internal fixation with a 3.5 mm LC-DCP plate was used in six patients of Group I, and K- wires were used in two patients of Group II. The deformity of the radius required corrective osteotomy with a 3.5 mm T-plate fixation in five patients of Group I, in two patients of Group II we used home produced plates, screws, and bone autoplasty with a spongy graft from the iliac crest (14); in one patient a «Bio-oss» graft was used. In 7 patients we used Ilizarov device and K-wires.

Results. Pain relief was achieved in 87% of the reexamined patients from the Group I and in 72% - from the Group II. Bone fragments united in 31 patients of Group I (86%) and in 9 patients (75%). In one case a plate broke resulting in the relapse of pseudarthrosis. Application of the AO fixators allowed early mobilization, which helped to avoid post immobility contractures. Grasping power restoration in Group I was 76% (grip strength) and 82% (pinch strength) of the uninjured side. In Group II grip strength was 55% and pinch strength − 69% of the uninjured side. In Group II there was consolidation in two cases of nonunity, Sudeck’s syndrome developed in two patients. Contractures and progressive arthrosis in the wrist were also observed. Recovery of Group I patients was 2.5 times quicker than in Group II and the functional results were much better in Group I throughout the whole course of treatment.

Conclusion. In comparison with conventional fixators, AO-plates (ORIF) help to perform anatomically accurate and stable osteosynthesis, which, in its turn, helps to promote early mobilization, to reduce the complications. All this leads to a fall in the disability rate and invalidity of patients.