A 40-year-old male was a front seat passenger in a car involved in a road traffic accident. He sustained fractures of the left 1st to 6th ribs, a left sided pneumothorax, pneumomediastinum, left scapula fracture, dislocation of the left little finger PIPJ as well as a crush injury of the left elbow with open fracture of the left humerus and proximal ulna. A chest tube was inserted and the little finger reduced. The elbow wound underwent debridement followed by external fixation and negative pressure dressing. Internal fixation of the humerus and ulna and soft tissue coverage with a free ALT flap were performed 13 days following injury. Nineteen months postoperatively active elbow motion was 115° (range, 15° to 130°) ().
Case 3. A 30-year-old male sustained a left elbow fracture with severed brachial artery for which vascular repair of the artery and fixation of the fracture were done. Nine months later he presented with exposure of the implant. He was very thin and had significant heterotopic calcification causing ankylosis of the elbow after injury. Due to the ankylosis and previous brachial artery injury exploration of vessels for free tissue transfer was difficult; therefore lateral abdominal perforator flap was used to cover the defect after implant removal (Figures and ). The coverage required 2 stages and was completed within 3 weeks. Ten months postoperatively his ROM was 70°, which was similar to his preoperative ROM.