PMC5937609_01
Injury at presentation in trauma bay, demonstrating gross contamination of the open fracture.
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fig1
Support protocol was initiated. She was intubated, and on further workup, she was found to have a right upper extremity- (RUE-) comminuted displaced fracture of proximal radius and ulna Gustilo grade IIIc open fracture with large degloving injury and gross contamination.  Figure 1 illustrates the large bony and subcutaneous tissue defect, and Figure 2(a) shows the X-ray of bony loss after application of an external fixator device while Figure 2(b) is the X-ray obtained in the trauma bay on initial arrival.
(a) AP X-ray after application of external fixator device demonstrating bony injury on initial injury after debridement. (b) AP X-ray showing the bony injury involving the ulna and radius, with a large amount of radial bone loss.
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fig2
Support protocol was initiated. She was intubated, and on further workup, she was found to have a right upper extremity- (RUE-) comminuted displaced fracture of proximal radius and ulna Gustilo grade IIIc open fracture with large degloving injury and gross contamination.  Figure 1 illustrates the large bony and subcutaneous tissue defect, and Figure 2(a) shows the X-ray of bony loss after application of an external fixator device while Figure 2(b) is the X-ray obtained in the trauma bay on initial arrival.
(a) The original debridement with the bony and soft tissue defect. (b) Antibiotic beads in the bony defect on figure fold with external fixator.
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fig3
The soft tissue injury measured 15 cm x 10 cm, as seen in Figure 3(a), which shows the original debridement soft tissue and bony defect.  Figure 3(b) demonstrates the bony defect with antibiotic bead placement.
AP and lateral X-rays of the patient's forearm on POD 75. The ulnar has an IMN nail, and the radius has an open reduction internal fixation of the fibular free graft demonstrating good alignment.
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fig4
Her X-rays on POD 75 showed appropriate interval consolidation without loosening of hardware, good positioning of radial head, and appropriate interval healing of the ulnar fracture around the IMN nail, as seen in Figure 4.