Healing and Wound Problems

Incidence of Wound Problems

Wound healing complications following elbow trauma have been documented; most of the literature relates to wound problems following surgical treatment of complex distal humerus fractures. Athwal et al. reported on a series of 32 patients with type C distal humerus fractures fixed with parallel plates, of whom 2 patients (6%) developed a superficial wound infection and 2 patients required a radial forearm flap. In a review of 34 fractures fixed with parallel plates, Sanchez-Sotelo et al. identified 3 patients (9%) who underwent additional surgical procedures for wound-related complications. Kundel et al. documented minor wound complications in 8 of 99 patients (8%) and more serious infections in 10% of patients, a number of whom were lost to follow-up; treatment strategies were not discussed.

Lawrence et al. performed a detailed retrospective review of 89 Mayo patients with distal humerus fractures, a third of which were open, who underwent open reduction and internal fixation. Patients were categorized into one of three groups: no wound complications identified, minor wound complications occurred (such as superficial wound infection or minor dehiscence that resolved with oral antibiotics and local wound care), and major complications developed (requiring return to the operating room for irrigation, débridement, delayed closure, and/or soft tissue coverage). In 72 patients (80.9%) the posterior wound healed without any complication. In three patients (3.4%) minor wound complications were evident, all of which resolved within 3 weeks of surgery with oral antibiotics and local wound care. Fourteen patients (15.7%) developed a major wound complication requiring on average 2.5 additional visits to the operating room. All patients underwent initial irrigation and débridement, and in three cases the wound was closed primarily, and no further surgical procedures were needed. The other patients were treated with either delayed primary wound closure (four patients), vacuum-assisted closure (one patient), or soft tissue coverage (six patients). The soft tissue coverage procedures included flexor carpi ulnari flaps in two cases and radial forearm flaps in four cases. Twelve of the patients with major wound complications had undergone olecranon osteotomies stabilized with plate fixation. Grade 3 open fractures and the use of an olecranon osteotomy approach with plate fixation were identified as significant risk factors for major wound complications ( p < .01) The mean range of motion (ROM) in the major wound complication group at last follow-up was 99.5 degrees (range 65–130 degrees) and 99.4 degrees (range 10–140 degrees) in those with no or minor wound problems. Hence, fracture healing rates and functional range of elbow motion did not appear to be affected by major wound complications when managed aggressively with appropriate techniques.