Temporizing and Definitive Skeletal Fixation for the Mangled Upper Extremity

Initial skeletal management of a mangled upper extremity may be temporary or definitive depending on the fracture, location, and patient condition. Scapula and clavicle injuries can often be treated non-operatively; however unusual constructs may be employed to control these injuries. The humerus and elbow may be addressed with external fixation or temporizing internal fixation strategies to create a stable platform for neurovascular repair. The forearm and wrist may be treated with a combination of splinting, external and internal fixation. Each case varies, and we discuss a range of options with radiographic examples for these scenarios to help plan for definitive management. Through a discussion of the considerations surrounding the case and the patient’s resuscitation, skeletal fixation can be approached with creative approach with careful foresight of the final surgical needs of the patient and those of the entire treatment team.