Currently main options for elbow joint reconstruction after complete loss are total elbow arthroplasty and arthrodesis. In severe cases none of these options are sufficient, therefore new solutions must be sought. Authors present novel technique for complete elbow joint reconstruction that can be used as an alternative in challenging cases.
Case report: 34-year-old male presented with large bone defects and no cartilage in left elbow joint. Temporary external fixation and previous debridement were done beforehand by colleagues from orthopaedic department. Patient had history of motor vehicle accident, fractures of left proximal and distal humerus, proximal ulna and femur. Elbow region fractures were open Gustillo Anderson II and developed deep infection after osteosynthesis.
Flap consisted of cartilaginous parts of lateral femoral condyle and lateral patella, iliotibial tract, skin island and synovial tissue. All parts were based on branches from superolateral genicular artery. Bone flap sizes were approximately 2.5x2.5 cm. Femoral condyle was fixed to distal humerus and patellar flap to proximal ulna with two 2.5 mm screws each. Iliotibial tract was used to reconstruct distal tendon of triceps muscle and lateral collateral Līgament. Skin island size was 7x3 cm and was used for covering soft tissue defect that occurred due to increased volume of reconstructed elbow joint. Synovial tissue was included for production of synovial fluid for neo-joint. End-to-end anastomosis with ulnar artery and subcutaneous vein were performed. Five months after surgery knee arthroscopy was performed and several free cartilage fragments were evacuated.
Six months after surgery all wounds are completely healed with no signs of infection. On computer tomography scans complete consolidation of bone flaps and visible joint space is evident. Active elbow flexion extension is 70/5/5 degrees. Pronation supination is 60/0/50. Patient is pain free and has no donor site morbidity despite extensive grafting.
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