A 40-year-old male was a driver of a car that overturned in a road traffic accident. He sustained a Gustilo IIIB open fracture dislocation of the right olecranon with degloving injury and 10 cm segmental loss of the right ulnar nerve (). Initial management included multiple wound debridement and external fixation. 11 days after injury, internal fixation of the olecranon was performed. The ulnar nerve gap was bridged with a 3-cable sural nerve graft (). A free ALT musculocutaneous flap was used to cover the elbow. The nerve grafts were buried in the forearm flexor/pronator muscle mass and covered with vastus lateralis muscle. The affected limb was immobilized in extension for 7 days. Despite using a flap with very well vascularised muscle, due to the severity of the injury and degree of comminution, he later developed septic arthritis and osteomyelitis necessitating removal of the implants. Heterotopic ossification developed subsequently. At latest review at 9 years 2-point discrimination was 7 mm, he had regained full hand function (intrinsic muscle power 4/5) and active range of motion at the elbow was 45° (range, 45° to 90°) (). He declined further surgery.
Case 1. An 80-year-old female with multiple comorbidities including ischemic heart disease and chronic renal failure developed an ulcerating squamous cell carcinoma of her right elbow measuring 7 × 5 cm. Radiological studies showed no bony or joint involvement. The resultant wide excision included the skin, subcutaneous tissue, and underlying muscle, with a defect size of 75 cm2 exposing the elbow joint capsule and ulnar nerve. To avoid prolonged operative time, the defect was covered with pedicled FCR and FCU muscles (). The postoperative course was uneventful and in 10 months postoperatively the range of motion (ROM) at the elbow was 90°.