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Patient Profile

• Age: 65 years
• Gender: Not disclosed
• Cause of Injury: Road Traffic Accident (RTA)
• Presentation: Severe elbow trauma with shattered bone fragments and a large open wound

Initial Assessment & Diagnosis

The patient presented with a complex open elbow fracture following a high-impact road traffic accident. Clinical and radiological evaluation revealed:

• Extensive comminution of the distal humerus and elbow joint
• Significant soft tissue damage with an open contaminated wound
• Poor bone quality and insufficient bone stock for routine internal fixation

Given the severity of injury, standard fixation techniques such as plates and screws were not feasible.

Why a Staged Surgical Approach Was Required

A single-stage definitive surgery was not advisable due to:

• High risk of infection from the open wound
• Severe soft tissue damage
• Bone fragmentation preventing stable fixation

Staged management was planned to prioritize patient safety and long-term functional outcome.

Stage 1: Wound Management & Stabilization

The first stage focused on:

• Thorough surgical debridement of the open wound
• Removal of contaminated and non-viable tissue
• Infection control with antibiotics
• Temporary stabilization of the elbow

This phase allowed the wound to heal and reduced the risk of deep infection before joint replacement.

Stage 2: Elbow Replacement Surgery

Once the wound healed and soft tissues stabilized, total elbow replacement was planned.

Key Surgical Challenges:

• Limited and fragile bone stock
• Distorted anatomy due to fracture comminution
• Ensuring stable implant fixation
• Protecting surrounding nerves and soft tissues

Despite these challenges, elbow joint replacement was successfully performed, restoring joint alignment and stability.

Post-Surgery Recovery & Rehabilitation

• Early controlled mobilization was initiated
• Pain and swelling were managed effectively
• A structured physiotherapy program focused on:
  • Gradual range-of-motion exercises
  • Strengthening of surrounding muscles
  • Functional use of the arm in daily activities

Outcome at 6 Weeks Follow-Up

At 6 weeks post-surgery:

• The elbow joint is stable
• The patient has achieved a decent functional range of motion
• No signs of infection or implant-related complications
• Continued improvement expected with ongoing physiotherapy

Conclusion

This case highlights the importance of:

• Individualized treatment planning in complex trauma
• Staged surgical management for open fractures
• Elbow replacement as a reliable option when fixation is not possible

With proper planning, surgical expertise, and rehabilitation, even severe elbow injuries can achieve good functional outcomes.

Who Is This Case Study For?

This case study is helpful for:

• Patients facing complex elbow injuries
• Caregivers seeking clarity on treatment options
• Medical students and professionals
• Anyone interested in understanding advanced trauma care and elbow replacement surgery

Educational content based on real-life orthopaedic trauma management.