External Fixation for Severe Open Fractures of the Humerus Caused by Missiles

OBJECTIVE:To evaluate the use of external fixation of the humerus after missile injuries. DESIGN:Retrospective. SETTING:University medical center. PATIENTS:Twenty-six soldiers with twenty-six open Gustilo type III fractures. INTERVENTIONS:Immediate external fixation. MAIN OUTCOME MEASURES:Clinical, functional, social, and rehabilitation criteria were evaluated. RESULTS:Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. CONCLUSION:External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.