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


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

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: 04-03-2021

Copyright Statement:  Copyright © 2020; The Author(s).


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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  1. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 1981;63(6):872–877. DOI: 10.2106/00004623-198163060-00002.
  2. Gates DH, Walters LS, Cowley J, et al. Range of motion requirements for upper-limb activities of daily living. Am J Occup Ther 2016;70(1):7001350010p1–7001350010p10. DOI: 10.5014/ajot.2016.015487.
  3. Vasen AP, Lacey SH, Keith MW, et al. Functional range of motion of the elbow. J Hand Surg Am 1995;20(2):288–292. DOI: 10.1016/S0363-5023(05)80028-0.
  4. Sardelli M, Tashjian RZ, MacWilliams BA. Functional elbow range of motion for contemporary tasks. J Bone Joint Surg Am 2011;93(5): 471–477. DOI: 10.2106/JBJS.I.01633.
  5. 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. DOI: 10.1097/00003086-198608000-00041.
  6. Bell TH, Ferreira LM, McDonald CP, et al. Contribution of the olecranon to elbow stability: an in vitro biomechanical study. J Bone Joint Surg Am 2010;92(4):949–957. DOI: 10.2106/JBJS.H.01873.
  7. McKeever KF, 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.
  8. Rommens PM, Kuchle R, Schneider RU, et al. Olecranon fractures in adults: Factors influencing outcome. Injury 2004;35(11):1149–1157. DOI: 10.1016/j.injury.2003.12.002.
  9. Muller LP, Kamineni S, Rommens PM, et al. Primary total elbow replacement for fractures of the distal humerus. Oper Orthop Traumatol 2005;17(2):119–142. DOI: 10.1007/s00064-005-1125-3.
  10. Merritt K. Factors increasing the risk of infection in patients with open fractures. J Trauma 1988;28(6):823–827. DOI: 10.1097/00005373-198806000-00018.
  11. Sanchez-Sotelo J. Total elbow arthroplasty. Open Orthop J 2011;5(1):115–123. DOI: 10.2174/1874325001105010115.
  12. Allieu Y, Marck G, Chammas M, et al. Total elbow joint allograft for long term posttraumatic osteoarticular loss. Follow-up results at twelve years. Rev Chir Orthop Reparatrice Appar Mot 2004;90(4):319–328. DOI: 10.1016/S0035-1040(04)70127-0.
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