Date: Thu, 2 Dec 2004 11:18:31 -0800 (PST)

From: Djoldas Kuldjanov

Subject: Open elbow fracture - segmental bone loss

Advise or suggestions Please,

43 y/o post female dominant arm with Gd 3 B open distal humerus fx with significant bone and soft tissue loss.

Only articular surface remains with enough bone for k-wires only.

The remaining distal metaphyseal bone is detached from articular surfaces and is only a thin cortical shell what the x-rays don't reveal is that the remaining trochlear/capitellar segment has also had the posterior 1/3 sheared off as well so we essentially are dealing with a distal segment that consists of 2/3 of a trochlea and capitellum k-wired together a portion of tricepts is intact to olecranon however lateral portion of triceps is shredded radial nerve intact but was totally bashed with n. palsy ulnar n. intact but with palsy as well median nerve intact.

Has had multiple debridements and we are about to achieve definitive wound closure with elbow spanned in ex-fix our thoughts included implanting a large AB spacer invaginated into prox shaft extending down to intact joint until soft tissue healing achieved then delayed plating and massive graft, but really not enough bone to attach to distal artic. Segments other thoughts AB spacer followed by distal humeral allograft When that becomes painful then convert to elbow replacement we're up for any reasonable suggestion or hospital willing to take in transfer thanks.

Tracy Watson / Djoldas Kuldjanov / Dave Karges / Jim Jackman

Reply at: Orthopaedic Trauma Association forum

Date: Fri, 3 Dec 2004 18:24:02 -0600

From: Steven Rabin

I'm thinking that a tumor prosthesis would be the best option.

Maybe I can get our elbow or tumor guy to take it off your hands, if you agree to take the infected supracondylar nonunion that I posted about 2 weeks ago! We can trade!

steve rabin

Date: Sat, 4 Dec 2004 11:03:48 +0500

From: Alexander Chelnokov

Hello Djoldas and colleagues

allograft When that becomes painful then convert to elbow replacement we're up for any reasonable

It seems to me no need to wait when it becomes painful - at that moment elbow motions can be lost. I agree with Steven about primary tumor prosthesis is the best option.

Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

Date: Fri, 10 Dec 2004 12:50:33 -0500

From: James Carr

I don't know if this would work, but... If I were to try and preserve his own elbow, it would be with bone shortening, then some type of long, countersunk minifrag fixation from the articular surface up into the shaft. This is of course much easier to do from the safety of my 15" flat screen monitor. It could always be protected with a spanning elbow fixator. postop. If you thought the pieces were too fragile for that right now, then wait 6-8 weeks, and come back with the same plan. I don't think I would try to maintain normal skeletal length, but the cement spacer is a good idea. The ulna can be fixed at this stage.

Jim Carr