Strategies in Trauma and Limb Reconstruction

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VOLUME 15 , ISSUE 2 ( May-August, 2020 ) > List of Articles

CASE REPORT

Natural History of a Traumatic Olecranon Loss Resulting in a “Reversed Elbow”: A Case Report

Filip R Hendrikx, Christiaan HW Heusdens, Pieter Van Dyck, Francis Van Glabbeek

Keywords : Elbow joint, Natural history, Neo-articulation, Olecranon fracture, Traumatic olecranon loss,Bone remodelling

Citation Information : Hendrikx FR, Heusdens CH, Van Dyck P, Van Glabbeek F. Natural History of a Traumatic Olecranon Loss Resulting in a “Reversed Elbow”: A Case Report. 2020; 15 (2):126-129.

DOI: 10.5005/jp-journals-10080-1456

License: CC BY-NC-SA 4.0

Published Online: 01-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Case description: A 58-year-old woman suffered an open displaced olecranon fracture with extensive soft tissue damage when she was involved in a car accident in Africa. Local doctors performed a debridement of the elbow. Later, she presented in our centre for further treatment. There was a possibility of active infection, for which antibiotics were given and a debridement was performed. We then applied dynamic external fixation to minimize infection risk. Physiotherapy started soon after. External fixation was removed after 2 months. On follow-up, the patient reported no pain and no signs of major instability were present. Therefore, we agreed not to perform additional surgery. Annual follow-up radiographs showed progressive remodelling of the joint. Eleven years after the initial trauma, a reversed elbow has formed. It is a fully functional neo-articulation that is shaped by osteophyte formation and erosion of ulna, radius and humerus. The patient is free of pain and shows intact flexion and supination, while extension and pronation are limited. She has regained good elbow function and can perform most of her daily activities. Conclusion: Invasive reconstructive surgery with implantation of foreign material should be avoided or postponed in heavily contaminated fractures to avoid infection. It could be valuable to consider a watchful waiting strategy, which sometimes results in a good functional end result. Nature can be kind, which has been proven in our case.


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