FOREARM FRACTURES CAUSED BY MACHETE WOUNDS

Abstract

Purpose of the study: Unlike thoracic and abdominal stab wounds, little has been reported about blade wounds to the forearm. We report a serie of machete wounds to the forearm treated in the Caribbean island Martinique, between 1997 and 2004.

Material and methods: This study included 14 open fractures of the forearm caused by machete wounds. This retrospective analysis was based on the patient files. We studied the mechanism of the fracture, the type and level of the fractures, the associated lesions, the type of treatment given, and complications observed.

Results: Mean follow-up was seven months. Among the 14 patients studied, 14 presented an ulnar fracture, and five a radial fracture. Five patients suffered a complete amputation of the hand. Ten patients (71%) also had associated tendon injuries, all on the ulnar side. Three associated vascular injuries were noted (21%), two on the ulnar side. There were four nerve lesions (29%) involving the ulnar nerve alone (n=2),the ulnar and medial nerves (n=1) or all of the nerve trunks (n=1). The fractures involved the distal third of the forearm in nine patients (64%) and were comminutive for ten (71%). A complete fracture was noted in twelve patients (86%) with a partial fracture in two. Osteosynthesis was performed in all cases. There were nine complications: early infection (n=2, due to late referral), stiff joints (n=6, 43% including tendon retraction in five), nonunion (n=2, one repeated case) and one late healing at one year. Motor and sensorial sequelae were observed at last follow-up in all patients with an initial nervous lesion.

Discussion: The mean follow-up in our patients was short because of the specific context (homelessness, drug addiction). Most of our patients refused medical follow-up. The strong predominance of bony or soft tissue injuries observed on the ulnar side of the forearm corresponds to the mechanism of defense used by the victims. Despite the fact that the wounds were soiled and that the patients failed to comply with medical advice, the rate of early and secondary infection was low. Stiff joints due to tendon retractions and motor deficits were however frequent and compromised the functional outcome.

Conclusion: Fractures of the forearm by machete wounds generally occur in a typical situation of self defense. The characteristic injury to the ulnar side of the forearm results from this mechanism. Tendon and nervous complications are common and cause invalidating sequelae. Secondary infection is exceptional. Prolonged regular follow-up could probably improve the functional outcome of these particular injuries.