Reconstruction of massive bone losses of the elbow with vascularized bone transfers.

Abstract

Massive bone loss of the elbow in young patients is a complex injury. A series of five cases of massive loss of the elbow joint reconstructed with single or double vascularized bone transfers is reported. Five patients with nonacute massive bone loss of the distal humerus (two cases) or distal humerus and proximal ulna (three cases) were reconstructed with a single (two cases) or double (three cases) microvascular vascularized bone transfer from the iliac crest, the fibula, or the scapula. Collateral ligament reconstruction was performed in a second stage. Follow-up was 1 to 3 years. All free flaps survived. There was one septic complication not affecting flap survival. The number of surgical procedures was 3.2 (range, two to five). Active range of motion was 86 degrees (range, 70 to 100 degrees), without significant pain and acceptable lateral stability. Treatment time was 7 to 13 months. Vascularized bone transfer can restore the articular gross anatomy in cases of massive destruction of the elbow. Midterm functional results have been favorable in a short series of young patients.