Fractures of the forearm resulting from low-velocity gunshot wounds.

Thirty-seven extraarticular fractures of the forearm resulting from low-velocity gunshot injuries were treated by cast immobilization or open reduction and internal fixation with dynamic compression plates. All patients received 72 h of intravenous antibiotics. There were 14 isolated ulna fractures, 17 isolated radius fractures, and six both-bone (radius and ulna) fractures. Cast immobilization was used in 22 of 23 nondisplaced or minimally displaced fractures and eight of 14 displaced fractures. The remaining seven fractures were treated by open reduction and internal fixation. All fractures united within 16 weeks of injury regardless of the method of treatment. Poor clinical results related to the fracture occurred in six patients, five of whom were treated by cast immobilization. Fourteen patients had nerve palsies; eight resolved spontaneously and six had permanent neurologic deficits. There were two compartment syndromes and one ulnar artery transection. There were no infections. We conclude that displaced fractures of the radius, and both bone fractures, are best treated by open reduction and internal fixation. All patients should be closely monitored for 24 h for compartment syndrome, regardless of the fracture type or pattern. Early dynamic splinting is important when associated nerve injuries are present.

Shielding of the patient's gonads during intramedullary interlocking femoral nailing.

Levels of exposure to radiation were recorded at sixty sites in fifteen patients during intramedullary interlocking femoral nailing. Radiation film dosimeters were placed at four gonadal sites on each subject. A standard male-gonad cup or a pelvic drape of 0.5-millimeter-thick lead-equivalent was put in place to shield the gonads. A second set of four dosimeters was placed external to the shield to approximate unprotected exposure. The total duration of the fluoroscopy averaged five minutes (range, thirty seconds to fourteen minutes). The total exposure to radiation external to the shield was 35 +/- 34 millirems at the male gonadal sites and 17 +/- 11 millirems at the female gonadal sites. With use of the gonadal shield, exposure to radiation was not measurable in thirteen of the fifteen patients. The differences between the exposures of the shielded and unshielded sites to radiation were statistically significant (p less than 0.001). The highest level of gonadal exposure was found with the treatment of proximal femoral fractures and with the use of statically locked nails. Regardless of the conditions, and for all types of fractures and locations, our results demonstrated that gonadal shielding is justified.