Restoring function in the upper limb after extensive injury: A comparision between military and civil trauma

Introduction: Complex injuries with multifragmentary fractures and extensive tissue damage can be found both in war and civil injuries. The aim of this case series is to highlight the differences as well as similarities in treating complex upper limb trauma in civil and military settings.

Cases: First is a 24-year-old male foreign soldier with a tertiary blast injury who was admitted to our hospital 2 months after the initial trauma. The main injury was a multifragmentary fracture of the right forearm, as well as a complete loss of function of the radial nerve. After multiple rounds of surgical wound debridement, soft tissue reconstruction was performed via a free vascularized flap reconstruction. A wound infection with Strep. Parauberis was successfully treated with local antibiotics. The function of the radial nerve was restored through a motor replacement plastic.

Second is a 30-year-old male who suffered a mangled left arm in a work accident. He sustained an III° open forearm fracture and massive soft tissue damage with complete destruction of the extensor apparatus. This patient too received initial immobilization via external fixation and multiple rounds of wound debridement with VAC-therapy. The definitive treatment of the fracture consisted of intramedullary nailing. The tissue defect was covered with a mesh-graft, and 6 months after the initial trauma he too received a motor replacement plastic.

Both patients were discharged with a satisfactory function of the hand.

Conclusion: The selected cases serve as an excellent comparison of the challenges in treating complex upper limb trauma sustained through military and civil trauma. In general, as well as in this particular case, the risk of infection is much higher in military injuries, which delays the conversion from initial to definitive treatment. Irregardless of the initial mechanism of injury, motor replacement plastic proved to be an excellent technique to regain a satisfactory function of the limb.

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