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°) ().
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.