RESUMEN
Case description: A 58-year-old woman suffered an open displaced olecranon fracture with extensive soft tissue damage when she was involved in a car accident in Africa. Local doctors performed a debridement of the elbow. Later, she presented in our centre for further treatment. There was a possibility of active infection, for which antibiotics were given and a debridement was performed. We then applied dynamic external fixation to minimize infection risk. Physiotherapy started soon after. External fixation was removed after 2 months. On follow-up, the patient reported no pain and no signs of major instability were present. Therefore, we agreed not to perform additional surgery. Annual follow-up radiographs showed progressive remodelling of the joint. Eleven years after the initial trauma, a reversed elbow has formed. It is a fully functional neo-articulation that is shaped by osteophyte formation and erosion of ulna, radius and humerus. The patient is free of pain and shows intact flexion and supination, while extension and pronation are limited. She has regained good elbow function and can perform most of her daily activities. Conclusion: Invasive reconstructive surgery with implantation of foreign material should be avoided or postponed in heavily contaminated fractures to avoid infection. It could be valuable to consider a watchful waiting strategy, which sometimes results in a good functional end result. Nature can be kind, which has been proven in our case. How to cite this article: Hendrikx FR, Heusdens CHW, Van Dyck P, et al. Natural History of a Traumatic Olecranon Loss Resulting in a "Reversed Elbow": A Case Report. Strategies Trauma Limb Reconstr 2020;15(2):126-129.
RESUMEN
There has been an increase in thrower-specific elbow injuries in recent years. High valgus stresses during the late cocking and acceleration phases of throwing need to be compensated by the flexor pronator muscles as these can exceed the tensile strength of the medial collateral ligament complex. Prevention of injuries is the priority, with a focus on strengthening, reducing throwing frequency, decreasing force, and promoting a technique. The spectrum of thrower injuries ranges from a simple sprain to complete failure of the valgus stabilizing factors. The medial collateral ligament can stretch, leading to posteromedial impingement and radiocapitellar compression forces. This in turn can result in arthrosis and the formation of osteophytes. Ligament failure may eventually occur, making it impossible for the athlete to continue their throwing activities. The outcome of conservative treatment with strengthening, improvement of technique, and relative rest is often disappointing. Direct repair may no longer be possible in these acute-on-chronic injuries and a reconstruction with a tendon graft may be necessary.
RESUMEN
Traditionally the heart is considered a terminally differentiated organ. However, at the beginning of this century increased mitotic activity was reported in ischemic and idiopathic dilated cardiomyopathy hearts, compared to healthy controls, underscoring the potential of regeneration after injury. Due to the presence of adult stem cells in bone marrow and their purported ability to differentiate into other cell lineages, this cell population was soon estimated to be the most suited candidate for cardiac regeneration. Clinical trials with autologous bone marrow-derived mononuclear cells, using either an intracoronary or direct intramyocardial injection approach consistently showed only minor improvement in global left ventricular ejection fraction. This was explained by their limited cardiomyogenic differentiation potential. To obtain more convincing improvement in cardiac function, based on true myocardial regeneration, the focus of research has shifted towards resident cardiac progenitor cells. Several isolation procedures have been described: the c-kit surface marker was the first to be used, however experimental research has clearly shown that c-kit+ cells only marginally contribute to regeneration post myocardial infarction. Sphere formation was used to isolate the so-called cardiosphere derived cells (CDC), and also in this cell population cardiomyogenic differentiation is a rare event. Recently a new type of stem cells derived from atrial tissue (cardiac atrial stem cells - CASCs) was identified, based on the presence of the enzyme aldehyde dehydrogenase (ALDH). Those cells significantly improve both regional and global LV ejection fraction, based on substantial engraftment and consistent differentiation into mature cardiomyocytes (98%).
