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            [0] => Conservative treatment in severe open upper limb fracture
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            [0] => HMPIT
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    [nom] => Array
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            [0] => Ghrissi
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    [prenom] => Array
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            [0] => Sirine
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    [email] => Array
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            [0] => ghrissisirine3@gmail.com
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Nom prénom / Name Surname: Khelil Khaled
Email: khaledkhelil@yahoo.fr
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Znagui Talel
Email: z_talel@yahoo.fr
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Mastouri Rihab
Email: rihabmastouri40@gmail.com
Hôpital / Hospital: Institut Kassab

 
Nom prénom / Name Surname: Abdennadher Achraf
Email: dr.achrafabn@gmail.com
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Amri Khalil
Email: akhalilkh@gmail.com
Hôpital / Hospital: HMPIT

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            [0] => Ghrissisirine3@gmail.com
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    [specialite] => Array
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            [0] => Chirurgie orthopédique et traumatologique
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    [pays] => Array
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            [0] => Tunisie
        )

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        (
            [0] => introduction : Severe upper limb trauma can be a traumatic turning point in a patient's life. The management is long and demanding and may require the intervention of mental health professionals. It represents an uncodified surgical challenge, the main complication of which is infection. The patient's expectations can also be a significant factor in the treatment modalities.
Method : The patient is a female who has been followed in our department since 2023. She was initially admitted for an open fracture of the left forearm, Gustilo 3b.
Case presentation : A 33-year-old right-handed woman was admitted for an open fracture of the left forearm, Gustilo 3b, presented with a 7 cm defect of the radial diaphysis,  vascular and nerve complications. She underwent emergency surgery with a salvage pinning and external fixation. A surgical debridement and suture of the ulnar artery were performed with good limb vitality.
Follow-up required multiple surgical debridements without septic complications. At 15 days post-trauma, a McGregor inguinal flap covering the entire anterior aspect of the forearm was performed.
The patient developed a complex regional pain syndrome, which delayed the planning of the reconstructive surgery. Then, a reconstruction with an inert fibula autograft was performed through a dorsal approach to the forearm and stabilized with two plates.
At the latest follow-up, the clinical examination showed good elbow mobility, wrist stiffness, and an aligned and stable limb. The Quick DASH score was 35%. 
Discussion : Some authors advocate for radical treatment. According to some studies, amputation would lead to better functional results and improve quality of life. However, reintegration into the workplace and psychological acceptance were not favorable.
No consensus has been reached on the management of severe upper limb trauma. In our case, we opted for conservative treatment guided primarily by the patient's request.
Conclusion : The management of severe upper limb trauma is long, difficult, and complex. Specialized psychological support is essential in the patient's rehabilitation. The conservative strategy can provide satisfactory functional results and improve quality of life.
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