Elbow Hemiarthroplasty for Late Reconstruction of a Traumatic Elbow Bone Defect in a Young Patient: A Case Report.

Abstract

Hemiarthroplasty of the human elbow was first described in 1947 by Mellen and Phalen1. Encouraging follow-up results with good range of motion and substantial pain relief after elbow hemiarthoplasty were published in 19742. Nevertheless, in cases with severe bone loss and comminution, the semiconstrained total elbow arthroplasty has been a very reliable solution during the last decades3,4, especially in elderly patients. However, in active patients with an injured dominant arm, the major mid and long-term complication of these semi or totally linked polyethylene components is the risk of loosening5. In younger patients, the new anatomic elbow hemiarthroplasty offers the possibility of greater mobility, stability, and promising long-term results6. We present the case of a young patient with a comminuted type-IIIB open fracture of the elbow with bone loss of the humeral condyles. After elbow hemiarthroplasty, the final follow-up (4.5 years postoperatively) showed that the treatment had been successful. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A thirty-one-year-old obese man (body mass index [BMI] of 35) without any other medical comorbidities presented to the emergency department following a motorcycle accident. Clinical and radiographic evaluation demonstrated an open intercondylar fracture (type IIIB according to the Gustilo-Anderson classification7) of the right dominant elbow, with bone loss of the humeral condyles and fracture of the olecranon tip. Complete radial nerve palsy was also noted. Immediate wound irrigation and surgical debridement were performed in the operating room. During surgical exploration, the radial nerve was found to be intact, and no major vascular injury was apparent. Because of extensive soft-tissue damage, internal fixation was not an option. An elbow-bridging external fixator (Orthofix, Lewisville, Texas) was applied, and a local skin flap was …