Upper limb reconstruction by humerus lengthening after forearm mangled injury: a case report

Objective: The current study was aimed at introducing a novel method to manage the mangled extremity by upper limb reconstruction using distraction osteogenesis. Methods: A 25-year-old man was admitted to our hospital after a severe mangled injury, his right forearm bones and the surrounding soft tissues were compromised. After initial debridement, the infection of his right forearm recurred. Unavoidably, the forearm bones of the patient were eradicated in the further debridement. His right humerus was lengthened by distraction osteogenesis to compensate for the loss of ulna and radius. The distraction period was about 340 days and 220 mm of humerus regenerate were formed. Moreover, at the ex-elbow site the humerus was bent 40° in flexion to allow for better function of forearm and hand. Results: Bone regeneration was achieved at the end of treatment. Two-year postoperative followup revealed no recurrent infection. The Surgery-Hand/Arm Grading System was used for evaluating the function of “newly formed” forearm after the whole treatment, and the score was significantly improved to 79. Conclusion: This case report indicates that severe mangled extremity could be salvaged, and bone distraction osteogenesis can play a very important role in managing this massive bone defect.