Kouvidis George K, Chalidis Byron E, Liddington Mark I, Giannoudis Peter V
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom.
Eplasty. 2008 Apr 29;8:e24.
Open intra-articular fractures of the distal humerus can be associated with considerable bone loss and extensive soft tissue damage. The management of these injuries is quite challenging, and the restoration of elbow anatomy may require multiple bone and soft tissue surgical procedures. The purpose of this case report is to present the option of addressing at the same time a complex skin, muscular, and bone distal humerus defect by using a composite vascularized graft.
We present a case of a high-energy open fracture of the distal humerus in a polytrauma young patient. Apart from the significant damage of all skin layers and underlying muscle units at the posterolateral side of the elbow, the medial column of the distal humerus (6 cm in length) was completely absent. After patient resuscitation and wound debridement, a free vascularized osteocutaneous fibular graft was used for the reconstruction of the bone defect and the restoration of elbow anatomy.
No complications were encountered during the postoperative period, and both bone and soft tissues progressed to sound healing. At 26 months follow-up, the patient had a functional and stable elbow and the Mayo Elbow Performance Score was 85 points, which is equivalent to a good result.
Vascularized osteocutaneous fibular graft could effectively address complex traumatic defects of the elbow joint and enhance the potential for bone healing and early functional recovery.
肱骨远端开放性关节内骨折可能伴有大量骨质流失和广泛的软组织损伤。这些损伤的处理颇具挑战性，恢复肘关节解剖结构可能需要多次骨和软组织外科手术。本病例报告的目的是介绍通过使用复合带血管移植物同时解决复杂的皮肤、肌肉和肱骨远端骨缺损的方法。
我们报告一例多发伤年轻患者的肱骨远端高能开放性骨折。除了肘部后外侧所有皮肤层和深层肌肉单位受到严重损伤外，肱骨远端内侧柱（长度为6厘米）完全缺失。在患者复苏和伤口清创后，使用游离带血管腓骨骨皮瓣移植重建骨缺损并恢复肘关节解剖结构。
术后未出现并发症，骨和软组织均顺利愈合。随访26个月时，患者肘关节功能良好且稳定，梅奥肘关节功能评分85分，相当于良好结果。
带血管腓骨骨皮瓣移植可有效解决肘关节复杂创伤性缺损，提高骨愈合潜力和早期功能恢复。
