Strategies in Trauma and Limb Reconstruction

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VOLUME 16 , ISSUE 1 ( January-April, 2021 ) > List of Articles

CASE REPORT

A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability?

Giulia Facco, Rocco Politano, Andrea Marchesini, Letizia Senesi, Pasquale Gravina, Pier Paolo Pangrazi, Antonio P Gigante, Michele Riccio

Keywords : Complex elbow injury, Elbow instability, 3D printing, Olecranon bone loss

Citation Information :

DOI: 10.5005/jp-journals-10080-1504

License: CC BY-NC-SA 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion.Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases. Case description: We discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported. Conclusion: In this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss.


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  1. Lobenhoffer P, Tscherne H. Definition of complex trauma and general management principles. Orthopade 1997;26(12):1014–1019. DOI: 10.1007/PL00003356.
  2. Chin TY, Chou H, Peh WCG. The acutely injured elbow. Radiol Clin North Am 2019;57(5):911–930. DOI: 10.1016/j.rcl.2019.03.006.
  3. Marinelli A, Guerra E, Rotini R. Elbow instability: are we able to classify it? Review of the literature and proposal of an all-inclusive classification system. Musculoskelet Surg 2016;100(Suppl 1):61–71. DOI: 10.1007/s12306-016-0424-1.
  4. Dipaola M, Geissler WB, Osterman AL. Complex elbow instability. Hand Clin 2008;24(1):39–52. DOI: 10.1016/j.hcl.2007.11.010.
  5. Sanchez-Sotelo J, Morrey M. Complex elbow instability: surgical management of elbow fracture dislocations. EFORT Open Rev 2017;1(5):183–190. DOI: 10.1302/2058-5241.1.000036.
  6. Giannicola G, Gumina S, Polimanti D, et al. Complex Elbow Instability: What's New in the Diagnosis, Classification and Principles of Surgical Treatment? Orthop Rheum Open Access J 2019;14(1): 555879. DOI: 10.19080/OROAJ.2019.14.555879.
  7. Guerra E, Marinelli A, Rotini M. Elbow stiffness. In: Porcellini G, Rotini R, Stignani Kantar S, et al. (eds) The Elbow: Principles of Surgical Treatment and Rehabilitation. Cham: Springer International Publishing; 2018. pp. 407–418. DOI: 10.1007/978-3-319-27805-6_30.
  8. Rommens PM, Küchle R, Schneider RU, et al. Olecranon fractures in adults: factors influencing outcome. Injury 2004;35:1149–1157. DOI: 10.1016/j.injury.2003.12.002.
  9. Öztürkmen Y, Şükür E, Akman YE, et al. Clinical and radiological evaluation of surgical management in olecranon fracture-dislocations. Musculoskelet Surg 2020;104(3):321–328. Epub ahead of print 3 October 2019. DOI: 10.1007/s12306-019-00623-0.
  10. Parchi PD, Ferrari V, Piolanti N, et al. Computer tomography prototyping and virtual procedure simulation in difficult cases of hip replacement surgery. Surg Technol Int 2013;23:228–234.
  11. Zeng C, Xiao J, Wu Z, et al. Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report. Int J Clin Exp Med 2015;8(8):13039–13044.
  12. Giannetti S, Bizzotto N, Stancati A, et al. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing. Injury 2017;48(3):784–788. DOI: 10.1016/j.injury.2016.11.015.
  13. Yang L, Grottkau B, He Z, et al. Three dimensional printing technology and materials for treatment of elbow fractures. Int Orthop 2017;41(11):2381–2387. DOI: 10.1007/s00264-017-3627-7.
  14. Shuang F, Hu W, Shao Y, et al. Treatment of intercondylar humeral fractures with 3D-printed osteosynthesis plates. Medicine (Baltimore) 2016;95(3):e2461. DOI: 10.1097/MD.0000000000002461.
  15. Tack P, Victor J, Gemmel P, et al. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016;15(1):115. DOI: 10.1186/s12938-016-0236-4.
  16. Ventola CL. Medical applications for 3D printing: current and projected uses. P&T Peer-Rev J Formul Manag 2014;39(10):704–711.
  17. Cho J, Park C-S, Kim Y-J, et al. Clinical Application of solid model based on trabecular tibia bone CT images created by 3D printer. Healthc Inform Res 2015;21(3):201–205. DOI: 10.4258/hir.2015.21.3.201.
  18. Baronio G, Harran S, Signoroni A. A critical analysis of a hand orthosis reverse engineering and 3D printing process. Appl Bionics Biomech 2016;2016:8347478. DOI: 10.1155/2016/8347478.
  19. Bizzotto N, Tami I, Tami A, et al. 3D Printed models of distal radius fractures. Injury 2016;47(4):976–978. DOI: 10.1016/j.injury.2016.01.013.
  20. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24:742–746. DOI: 10.1097/00005373-198408000-00009.
  21. Trail IA. The elbow and its disorders, 2nd Edn. J Hand Surg 1993;18:807–808. DOI: 10.1016/0266-7681(93)90254-D.
  22. Beaton DE, Wright JG, Katz JN, et al. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038–1046. DOI: 10.2106/JBJS.D.02060.
  23. Iobst CA. New technologies in pediatric deformity correction. Orthop Clin North Am 2019;50(1):77–85. DOI: 10.1016/j.ocl.2018.08.003.
  24. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 1986;68:669–674.
  25. Crosio A, Mattei L, Blonna D, et al. Anatomy and specimens. In: Porcellini G, Rotini R, Stignani Kantar S, et al. (eds) The Elbow: Principles of Surgical Treatment and Rehabilitation. Cham: Springer International Publishing; 2018. pp. 19–28.
  26. Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res 2004;(429):292–300. DOI: 10.1097/01.blo.0000142627.28396.cb.
  27. Marinelli A, Cavallo M, Guerra E, et al. Does the presence of posterior comminution modify the treatment and prognosis in capitellar and trochlear fractures? Study performed on 45 consecutive patients. Injury 2018;49(Suppl 3):S84–S93. DOI: 10.1016/j.injury.2018.09.060.
  28. Dushuttle RP, Coyle MP, Zawadsky JP, et al. Fractures of the capitellum. J Trauma 1985;25(4):317–321. DOI: 10.1097/00005373-198504000-00006.
  29. Alvarez E, Patel MR, Nimberg G, et al. Fracture of the capitulum humeri. J Bone Joint Surg Am 1975;57(8):1093–1096.
  30. Garner MR, Schottel PC, Hotchkiss RN, et al. Capitellum Fracture fragment excision: a case Series. HSS J 2015;11(3):204–208. DOI: 10.1007/s11420-015-9452-x.
  31. An KN, Morrey BF, Chao EY. The effect of partial removal of proximal ulna on elbow constraint. Clin Orthop Relat Res 1986;(209):270–279.
  32. McKeever FM, Buck RM. Fracture of the olecranon process of the ulna; treatment by excision of fragment and repair of triceps tendon. J Am Med Assoc 1947;135(1):1–5. DOI: 10.1001/jama.1947.02890010003001.
  33. Sullivan CW, Hayat Z. Olecranon fracture. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. http://www.ncbi.nlm.nih.gov/books/NBK537295/ (accessed 15 April 2020).
  34. Pizzoli A, Bondi M, Schirru L, et al. The use of articulated external fixation for complex elbow trauma treatment. Musculoskelet Surg. Epub ahead of print 27 November 2019. DOI: 10.1007/s12306-019-00632-z.
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