PMC3058185_01
Plain radiographs (a, b) showing the healing of fractures 1 year after the first floating elbow injury
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Fig1
Radial head resection was also carried out (Fig. 1).
AP (a) and lateral (b) radiographs at hospital admittance show supracondylar fracture of the humerus and midshaft fractures of radius and ulna (second floating elbow injury). The CT scan (c) of distal humerus demonstrates the intercondylar integrity with an intra-articular bridge resulting from the previous treatment
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Fig2
In detail, a fracture of the humerus close to the most proximal screw occurred, the ulna had a fracture distally to the former fracture with an intermediate third fragment, while the radius sustained a fracture at the site of the most proximal screw (Fig. 2a, b). A CT scan (Aquilion 64-slice CT, Toshiba Corporation, Japan) showed integrity of the intercondylar bone, with the implants of the former operation stable (Fig. 2c).
The radial nerve is proximally dissected so that its course on the posterior side of the humerus is clearly identified and the Y plate can be safety positioned
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Fig3
The radial nerve was also dissected and fully mobilized (Fig. 3) to avoid its improper stretching caused by muscle spreading at the time of plate positioning.
Anteroposterior and lateral radiographs showing healing of forearm (a, b) and humeral (c, d) fractures 1 year postoperatively
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Fig4
The patient's fractures partially consolidated within 3 months and radiological evaluation 1 year after surgery showed the union of all fractures (Fig. 4).
Photographs (a, b, c, d) showing active motion of the right elbow in comparison with the uninjured contralateral limb 18 months after the second injury
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Fig5
At 18-month follow-up, the LES score was 5.72 and the patient had reduced but painless elbow range of motion compared to the opposite side (Fig. 5).