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- Title
CHALLENGING CONVENTIONS IN ELBOW ARTHROPLASTY: A CASE REPORT ON SEVERE OPEN FRACTURES WITH EXTENSIVE BONE LOSS.
- Authors
Moldovan, Alexia Nicola; Răchită, Adriana-Anastasia; Solyom, Arpad
- Abstract
Introduction: Increasing the use of total elbow arthroplasties challenges conventional contraindications, as demonstrated in our case study of a type III C open fracture. Despite potential complications, our approach prioritized patient comfort and limb functionality, emphasizing the importance of infection prevention, soft tissue coverage, and timely intervention. This paper highlights the feasibility and outcomes of elbow prostheses in complex fractures, advocating for flexible surgical strategies. Case Report: In an intricate case of severe upper extremity trauma resulting from a car accident, a 50-year-old patient underwent a comprehensive treatment culminating in total elbow arthroplasty (TEA) using an endoprosthesis, one-year post-injury. Initial injuries included type III C open fractures of the left distal humerus and proximal forearm, with substantial bone loss and nerve damage. Following initial wound debridement and stabilization, the focus shifted towards restoring elbow function through arthroplasty. The TEA procedure was meticulously planned to address the challenges posed by previous trauma and the extensive loss of bone. A significant aspect of this surgery was the utilization of a prosthetic device, which obviates the need for condylar reconstruction, thus simplifying the integration into the existing bone structure. Preparation involved careful rasping of the humerus and ulna, ensuring a precise fit for the prosthesis. The surgical strategy included the use of high-viscosity cement for securing the prosthesis, reinforced by a cerclage band for added stability. Moreover, a bone allograft compensated for the pronounced bone deficit, highlighting the adaptability of the chosen prosthesis to complex cases. Postoperative results demonstrated a substantial improvement in elbow functionality. Despite a permanent limb shortening, the patient achieved significant gains in motion range and muscle function, underscored by a notable increase in the Mayo Elbow Score from 30 to 80. Radiographic follow-up confirmed the successful integration of the prosthesis, without evidence of radioulnar synostosis. Discussions : Our case report emphasizes the effective application of TEA in managing a complex open fracture with significant bone loss and nerve damage, challenging traditional contraindications. It underscores the importance of timely, multidisciplinary intervention, meticulous initial osteosynthesis, and postoperative rehabilitation, highlighting TEA's expanding therapeutic indications despite potential complications such as ulnar nerve palsy. Conclusions: This case exemplifies the critical role of TEA in the rehabilitation of severe elbow injuries. The use of a prosthetic device, alongside strategic surgical interventions, facilitated remarkable functional recovery, offering insights into managing challenging orthopedic cases.
- Subjects
ROMANIA; ARM injuries; BONE resorption; WOUNDS &; injuries; TOTAL elbow replacement; COMPOUND fractures; CONFERENCES &; conventions; ARTIFICIAL joints; ELBOW joint
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p162
- ISSN
2668-7755
- Publication type
Article