COMPOUND COMMINUTED FRACTURES INVOLVING THE ELBOW JOINT

Treatment by Resection of the Fragments

¹ Captain, Medical Corps, United States Naval Reserve

Surgical resection of the fragments following a compound comminuted fracture involving the elbow joint was without major complications. The Procedure was carried out in the presence of open draining wounds, in the primary, intermediate, or secondary phase of the injury. The patient was ambulatory from the first day after operation. Elbowmotion was started after two weeks, and no mechanical support other than a sling was used.

The operative wound was closed primarily when penicillin was used. The temperature, pain, fusiform swelling, and drainage subsided after the resection. The operative wound healed primarily within two weeks. The healing time of the wound of injury depended upon the extent of soft-tissue damage.

The functional result was better when there was little loss of bone substance. If the trochlear surfaces of the humerus and ulna had been preserved, the elbow joint to all intents and purposes functioned normally. With the loss of the olecranon or the condyles of the humerus, the power of extension was sacrificed. The loss of the trochlear surface of the ulna added lateral instability in relaxation and slight loss of flexion power. The loss of the condyles of the humerus, alone or in conjunction with the proximal portions of the ulna and radius, resulted in about the same degree of additional loss in power of flexion against resistance and in further instability of the joint. Lateral instability of more than 45 degrees resulted in loss of ability to abduct the extended arm. Resection of two or three inches of the humerus resulted in a longer period before the power of flexion was regained, and in the most unstable joints. Even with a plastic repair, three inches was considered the greatest resection possible. The ability actively to supinate and pronate the forearm was, with one exception, dependent upon the absence of the head of the radius. Three patients were improved by a secondary operative removal of the head of the radius. The only patient who had a supination deformity failed to have the head of the radius removed. In all cases, pronation was more difficult to obtain than supination. A joint space did not reform at the site of the resected elbow, but fibrous scar tissue persisted between the bone ends six months after operation. Following operation, the formation of bone spicules at the bone ends was observed, but this had not resulted in loss of function.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				B. Youssef, S. Youssef, S. Ansara, and K. Porter Fractures of the distal humerus Trauma, April 1, 2008; 10(2): 125 - 132. [Abstract] [PDF]