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 61-year-old man sustained a left olecranon avulsion fracture after he tripped and fell, landing on his left elbow. His repair was complicated by staphylococcus aureus wound infection requiring removal of hardware, debridement and negative pressure wound therapy. A free ALT perforator flap based on the oblique branch of the lateral circumflex femoral artery was used for soft tissue coverage once the infection was cleared. Two months after coverage active elbow flexion is 140° (range, 0° to 140°) ().