Open Distal Both-Bone Forearm Fracture-dislocation with Wrist-Spanning External Fixation Following Hoverboard Fall

Chief Complaint

Pain, deformity, and open wound with exposed bone to the right wrist and distal forearm following a fall from a hoverboard.

History of Present Illness

46-year-old male with no significant past medical history, presented to the emergency department on the evening of 26 August 2022 following a fall backwards while using a hoverboard. During the fall, the patient sustained significant trauma to the right upper extremity.

On presentation, the patient complained of severe pain, visible deformity, and an open wound involving the right wrist/distal forearm region with exposed bone. He denied loss of consciousness, head injury, chest trauma, abdominal trauma, or injuries to any other extremities. No constitutional symptoms were reported.

Physical Examination

General:

Alert, oriented, and hemodynamically stable.

Right Upper Extremity:

Right wrist/distal forearm noted with the following:

-Open wound over the ulnar aspect of the wrist/distal forearm

-Protrusion of both the radius and ulna through the wound

-Minimal gross contamination noted

-Severe tenderness and pain on attempted movement

-Palpable radial and ulna pulses

-No neurovascular compromises noted by preserved sensory and motor functions of median, ulnar and radial nerves.

-Capillary refill less than 3 seconds

Radiology

Right Forearem Both Bone distal radius and ulna metaphyseal fracture-dislocation

Initial Management:

Wound Irrigation with 0.9% Normal saline and layered wound dressing  with wet-to-dry gauge and application of backslab and STAT doses do analgesics and antibiotics.

Operating Theater Management

Given the open nature of the fracture and exposed bone, the patient was taken emergently to the operating theater where the following procedures were performed:

• Extensive wound irrigation
• Aggressive wound debridement
• Reduction of fracture fragments
• Application of wrist-spanning external fixation

This reduces the risk of:

• Deep infection
• Osteomyelitis
• Soft tissue necrosis
• Neurovascular deterioration
• Malunion or nonunion

The external fixator was selected to:

• Restore length and alignment
• Maintain fracture stability
• Protect soft tissue integrity
• Allow ongoing wound surveillance and dressing care

Postoperative Course

The patient was admitted to the surgical ward for three days for:

• Neurovascular monitoring
• Intravenous antibiotics
• Analgesia
• Serial dressing changes
• Observation for compartment syndrome or infection

Open fractures of the distal radius and ulna constitute orthopedic emergencies due to the high risk of infection, soft tissue compromise, neurovascular injury, and long-term functional impairment. Prompt recognition and appropriate surgical management are essential to optimize outcomes and preserve limb function. This case discusses the successful management of a Gustilo-Anderson type II open distal both-bone forearm fracture sustained following a hoverboard fall in a middle-aged male. Management included urgent irrigation and debridement, fracture reduction, wrist-spanning external fixation, serial neurovascular monitoring, and structured rehabilitation. Despite transient postoperative neuropathic symptoms and mild wrist stiffness, the patient achieved excellent functional recovery without long-term disability.

This case illustrates several important orthopedic principles:

1. Early Surgical Debridement

Prompt irrigation and debridement remain foundational in open fracture management and significantly reduce infection risk.

2. Damage Control Stabilization

External fixation provided rapid stabilization while preserving access to soft tissues and minimizing further operative trauma during the acute inflammatory phase.

3. Importance of Neurovascular Monitoring

Despite severe skeletal injury and exposed bone, the patient maintained intact neurovascular status throughout treatment, contributing significantly to his favorable outcome.

4. Rehabilitation and Functional Recovery

Prolonged immobilization across the wrist often results in postoperative stiffness. Early physiotherapy and patient compliance were central to recovery.

5. Post-Traumatic Neuropathy Consideration

Transient paresthesia and concern for carpal tunnel syndrome are recognized sequelae following distal forearm trauma and external fixation. Conservative management was appropriate in this patient due to limited symptoms and preserved function.