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.
A 34-year-old male patient was admitted to our center. He had malunion of the distal humerus of his dominant arm (), accompanied with elbow stiffness (), and evident signs of osteoarthritis were seen on radiographs (Figures and ).\nThe study was approved by the hospital's Ethical Review Board, and it was conducted in accordance with the principles of the Declaration of Helsinki and its amendments. We fully informed the subject, and he gave his consent.\nThe patient underwent Grika interposition arthroplasty (see surgical technique paragraph and ) followed by a suitable rehabilitation protocol (see Rehabilitation Protocol and ). The external fixator which was used for initial support was removed 14 weeks after surgery.\nThe injured side (IS) and the noninjured side (NIS) were compared during the clinical follow-up. Function was evaluated with subjective quality of life measured by the Mayo Elbow Performance Score (MEPS) [].\nObjective function was evaluated by range of motion, flexion strength, and supination strength. A calibrated hydraulic dynamometer was used for the strength measurements. During these strength measurements, five measurements were taken by the same evaluator. The mean score of the last four was calculated as the first measurement was disregarded to avoid bias because of a learning curve caused by the patient's awareness.\nAt 1 year after surgery, both the MEPS and muscle strengths showed a difference in favor of the NIS. At 5 years of follow-up, the IS had a flexion strength of 98% of the NIS (28.9 N versus 29.5 N) and supination strength of 98% of that in the NIS (4.6 versus 4.7) and a MEPS of 100. Functional outcomes are shown in .\nThe patient was monitored for any postoperative complications.