Delayed reconstruction for olecranon fracture with extensive soft tissue injury and bone loss: A case report

Abstract

Delayed surgery for intraarticular fractures of the elbow is usually avoided, especially to prevent complications such as stiffness. We described an interesting case of a young patient who presented with open fracture of right olecranon, with extensive soft tissue injury and bony loss. He was treated with a 3-stage surgical procedure, prioritising on the soft tissue healing first before undergoing a delayed, definitive fixation of the olecranon, which was done 4 weeks after the trauma. The 3 stages include initial debridement and temporary skeletal stabilisation using Kirschner wires and external fixator, second look debridement with shoelace (dermato-traction) technique of delayed wound closure, and a definitive, reconstructive surgery using tricortical iliac bone graft with anatomical locking plate. The subsequent radiographs showed restored articular congruency of the elbow joint, before the olecranon eventually achieved bony union. He recovered well with excellent outcomes, as the elbow range of motion achieved almost full flexion at 120° and the extension lag at 10° and the Disabilities of the Arm, Shoulder and Hand (DASH) score of 3.3 was recorded. Delayed reconstructive surgery for olecranon fracture with extensive soft tissue and bone loss is a viable option to avoid complications, including infection and non-union. A judicious consideration by prioritising soft tissue management over expeditious bony surgery is important to achieve excellent outcomes.