PMC5541799_01
After thorough surgical debridement, a considerable soft tissue defect was created and bone was left exposed.
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We used vacuum assisted closure system (VAC, KCI Kinetic Concepts Inc., San Antonio, TX) combined with administration of culture specific antibiotics to resolve the problems of infection and poor bone coverage (Figure 1).
One external fixator was applied to each bone, radius, and ulna. They were used for segmental bone transportation of the radius and later distraction osteogenesis of both radius and ulna.
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An ulnar osteotomy was performed at the same surgical procedure, because the ulna had already been healed and distraction osteogenesis of both radius and ulna commenced after a week at the same rate of 0.25 mm/6 hours to restore the length of the forearm (Figure 2).
Two years after the final operation. The surgical wound has healed uneventfully. The patient can extend his wrist and fingers, and the thumb is out of the palm.
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The grip strength was 80% of the contralateral side and he reported no pain on daily activities (Figure 3).