Elbow Hemiarthroplasty for Late Reconstruction of a Traumatic Elbow Bone Defect in a Young Patient A Case Report Konstantinos Ditsios, MD, PhD, Achilleas Boutsiadis, MD, Filon Agathangelidis, MD, Minos Tyllianakis, MD, PhD, and Anastasios Christodoulou, MD, PhD Investigation performed at the First Orthopaedic Department of Aristotelian University of Thessaloniki, ‘‘G. Papanikolaou’’ General Hospital, Thessaloniki, and the Department of Orthopaedic Surgery, Medical School, University of Patras, Rion, Greece H emiarthroplasty of the human elbow was first de- scribed in 1947 by Mellen and Phalen 1 . Encouraging follow-up results with good range of motion and substantial pain relief after elbow hemiarthoplasty were pub- lished in 1974 2 . Nevertheless, in cases with severe bone loss and comminution, the semiconstrained total elbow arthroplasty has been a very reliable solution during the last decades 3,4 , es- pecially in elderly patients. However, in active patients with an injured dominant arm, the major mid and long-term compli- cation of these semi or totally linked polyethylene components is the risk of loosening 5 . In younger patients, the new anatomic elbow hemiarthroplasty offers the possibility of greater mobility, stability, and promising long-term results 6 . We present the case of a young patient with a commi- nuted type-IIIB open fracture of the elbow with bone loss of the humeral condyles. After elbow hemiarthroplasty, the final follow-up (4.5 years postoperatively) showed that the treat- ment had been successful. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. Case Report A thirty-one-year-old obese man (body mass index [BMI] of 35) without any other medical comorbidities presented to the emergency department following a motorcycle accident. Clinical and radiographic evaluation demonstrated an open intercondylar fracture (type IIIB according to the Gustilo- Anderson classification 7 ) of the right dominant elbow, with bone loss of the humeral condyles and fracture of the olecranon tip. Complete radial nerve palsy was also noted. Immediate wound irrigation and surgical debridement were performed in the operating room. During surgical ex- ploration, the radial nerve was found to be intact, and no major vascular injury was apparent. Because of extensive soft-tissue damage, internal fixation was not an option. An elbow-bridging external fixator (Orthofix, Lewisville, Texas) was applied, and a Fig. 1 Radiograph of the right elbow showing complete destruction of the humeral articular surfaces. Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. 1 COPYRIGHT Ó 2013 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED JBJS Case Connect 2013;3:e129 d http://dx.doi.org/10.2106/JBJS.CC.M.00137 Downloaded From: http://caseconnector.jbjs.org/ by a UNIVERSITY OF WATERLOO User on 12/16/2013