The patient is a 19 year old female involved in a motor vehicle accident as a restrained driver. She presented to an outside emergency room with complaints of left shoulder and arm pain. She was noted to have multiple abrasions and lacerations including two open wounds on the lateral aspect of her left elbow. There was fat and bone protruding from the wound. There was no gross contamination of the wound.
Radiographs obtained at the outside hospital demonstrated a comminuted fracture of the distal humerus, a fracture of the olecranon, and a non-displaced fracture of the clavicle. Her immediate treatment consisted of IV antibiotics, tetnus prophylaxis, a sterile dressing, and an emergent trip to the operating room for debridement and irrigation of the wound. Portions of the lateral column of the distal humerus were noted to be missing, or devoid of soft tissue attachments. The anterior portion of the capitellum was free in the wound and replaced after completion of the debridement. Traction radiographs are obtained to better delineate the injury in the operating room. Figure 1 & Figure 2
The patient’s wounds were closed over a drain, a spanning external fixator was placed, and her wounds were dressed sterilely. She was maintained on a cephalosporin and aminoglycoside post-operatively.
The patient did not have any associated injuries. She was transferred for further care. On arrival to our institution, she was 48 hours from injury. A treatment plan is required.