PMC8084658_01
(a-c) Preoperative X-ray imaging of the operative left elbow showing prosthetic loosening and periprosthetic fracture. (a) AP imaging of the left elbow with new periprosthetic fracture of the medial epicondyle and significant soft tissue swelling. (b) Oblique imaging of the left elbow again demonstrating a periprosthetic fracture of the medial epicondyle and lucency around the lateral aspect of the humeral implant. (c) Lateral X-ray of the left elbow demonstrating both ulnar and humeral component lucency concerning for infection.
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fig1
ROM of the left elbow of 30-90 , and no neurovascular deficits. Radiographic imaging demonstrated signs of loosening of both humeral and ulnar components, ulnar osteolysis concerning for infectious etiology, and a new periprosthetic fracture of the medial epicondyle (Figure 1).
(a, b) Intraoperative images showing active infection at the time of the first stage of revision surgery. (a) Posterior aspect of the left arm and elbow with abscess with a lateral paratricipital region and direct communication to a joint (white *) and (b) close-up of walled off abscess of the left elbow.
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fig2
Dissection into subcutaneous tissue exposed a purulent fluid collection with signs of communication to the underlying joint (Figure 2).
(a, b) Five-month postoperative images following first-stage revision surgery. (a) AP humeral X-rays showing delayed healing of the humeral shaft fracture and antibiotic spacer of the humerus, ulna, and elbow joint. (b) Lateral humerus X-ray showing incomplete healing of the humeral shaft fracture.
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fig3
Computed tomography (CT) imaging (not available) and radiographs revealed a left humeral shaft fracture with incomplete union (Figure 3).
Intraoperative images showing a "sandwich" technique of the femoral strut allograft and total elbow arthroplasty with 50 mm distal augment. Triceps tendon (black <) released off the ulna in a continuous sleeve with anconeus muscle. Ulnar nerve (yellow *) marked with a vessel loop to ensure protection throughout the procedure.
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fig4
The elbow was reduced and components were linked (Figure 4).
(a-c) 9-month postoperative clinic photos showing functional motion (10-130 degrees). (a, b) Symmetric elbow flexion with 130 degrees of the surgical elbow and 140 of the contralateral elbow. (c) Symmetric elbow extension with the surgical (left) elbow demonstrating 10 degrees short of full extension compared to the full extension of the contralateral elbow.
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(a-d) 12-month postoperative X-ray images: (a) lateral humerus X-ray; (b) AP humeral X-ray; (c) lateral elbow X-ray; (d) AP elbow X-ray.
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fig6
TEA components without signs of failure or loosening or resorption of the strut allograft (Figure 6). The patient is scheduled for a follow-up at 2 years from her revision surgery.