External fixation with limited internal fixation for Gustilo–Anderson Grade 3B open humerus and intra-articular elbow fractures: A case report with a 10-year follow-up

Abstract

Open fractures involving both diaphyseal and intra-articular comminuted fractures in the ipsilateral upper extremity present a complex clinical challenge. Management is dictated by the condition of the soft tissues, requiring thorough debridement, early soft tissue coverage, and appropriate bony stabilization. Diaphyseal fractures generally require functional reduction and relative stability, while intra-articular fractures demand anatomical reduction and absolute stability for optimal healing. A 21-year-old male sustained a Gustilo–Anderson Grade 3B open fracture of the humeral shaft, combined with comminuted intra-articular fractures of the distal humerus and proximal ulna due to a stone crusher injury. The wound was heavily contaminated, with bone exposure. The patient underwent thorough surgical debridement followed by fixation using a triangular external fixator combined with limited internal fixation via K-wires and cortical screws. After 3 weeks, additional screw fixation of the distal humerus was performed, and the forearm fixator assembly was removed to initiate early mobilization. Radiological union was confirmed at 12 weeks. At over 10 years follow-up, the patient demonstrated stable, painless elbow function with near-normal range of motion and was able to resume heavy manual work. In severe open fractures involving both diaphyseal and intra-articular components of the upper extremity, a hybrid fixation technique combining external fixation with limited internal fixation is effective. This approach facilitates wound management, reduces infection risk, and allows early mobilization, resulting in satisfactory long-term clinical and radiological outcomes.

Level of Clinical Evidence: Level IV.