Reconstruction of an elbow destroyed in gas explosion with total elbow replacement: a case report

Abstract.

A 25-year-old man severely injured his left elbow and lost his right hand in a gas explosion. The left forearm fracture was plated, the elbow debrided, an external fixator was applied, and the skin defect closed using local flaps and a split skin graft. Six months later the elbow was immobile due to an intra-articular fibrosis; a fully constrained hinged elbow replacement (Protetim) was implanted. Five weeks later there was a wound breakdown due to infection; the prosthesis became exposed. To salvage the limb, a latissimus dorsi myocutaneous neurovascular island flap was used to cover the soft tissue defect. Postoperative progress was uneventful and 30–100° of elbow flexion was achieved. One year later, the elbow replacement loosened without evidence of infection and it was replaced with a semiconstrained Coonrad-Morrey joint (Zimmer). In addition, the enlarged medullary canal of the humerus and ulna was packed with a morsalized homologous bone graft. One year after the revision and 3 years after the initial injury, the elbow is fully stable and pain-free with 5–120° of flexion and 40° of rotation. The patient works as a tradesman and is satisfied with the preserved function of his left hand.