Surgical Treatment of an Open Elbow Dislocation with Vascular Injury: A Case Report

SummaryOpen elbow dislocations with vascular injury are rare injuries and they most commonly occur after a fall from a high or in sports accidents. Close anatomic proximity of the joint to the neurovascular structures put them at risk of concomitant injury. The aim of this paper is to present the method of treatment of this severe injury.Herein we present a case of a female patient, 43 years old. She had suffered an open elbow dislocation with vascular injury as a result of a fall from the height of 1.5 meters. Seven hours after sustaining the injury and short preoperative preparation, reposition of the elbow, reconstruction of the vascular injury, adequate surgical treatment of the wound and external fixation of the elbow with the Mitković type external fixator were performed under general anesthesia. Four weeks after elbow stabilization with the external fixation, the external fixator was removed. The neurovascular status and final functional result of the treatment after six mounts were good.Urgent reposition, artery and vein reconstruction, and external fixation are essential in achieving good results in patients with open cubital dislocation accompanied with vascular injury. The Mitković type external fixator provides fast and stable fixation of the elbow after reposition and good conditions for wound care.

Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.