Intra-articular Olecranon Osteotomy and Adhesiolysis for Treatment of Post-traumatic Elbow Stiffness.

INTRODUCTION: Loss of motion is common in elbow trauma. Restoration of joint motion in post-traumatic stiff elbow can be a difficult, time consuming, and costly. We report a case of post-traumatic elbow stiffness treated with intra articular olecranon osteotomy and adhesiolysis. CASE PRESENTATION: A 30-year-old female, with right dominant upper extremity, presented 13 months after operated well aligned right intra articular distal humerus fracture with right elbow stiffness. She had a fixed flexion deformity of 20 degrees with flexion arc of 20-30 degrees and completely free supination and pronation. She was unable to perform the activities of daily living with affected right upper extremity. Intra-articular chevron olecranon osteotomy and adhesiolysis were done for the post-traumatic elbow stiffness. Immediate post-operative active and active assisted motion exercises of elbow joint were started. Indwelling infra clavicular catheter with continuous Ropivacaine infusion was kept for analgesia. At 6 month post-operative follow-up, she achieved 10-110 degree elbow flexion arc with completely free supination and pronation. She is able to perform the daily living activities with right upper extremity. CONCLUSION: Many different methods of treating post traumatic stiff elbow have been described, intra articular olecranon osteotomy helps in addressing intrinsic and extrinsic pathology with better results.

Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation.

In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.