{"title":"Reconstruction of a 10-cm Defect in the Distal Humerus Using a Lambda-Shaped Free Vascularized Fibular Flap: A Case Report.","authors":"Agraharam Devendra, Asif Imran, Hari Venkatramani, Kannan Balaraman, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran","doi":"10.2106/JBJS.CC.24.00268","DOIUrl":null,"url":null,"abstract":"<p><strong>Case: </strong>A 48-year-old man with multiple injuries sustained a Gustilo type 3A right open distal humerus fracture with a 4-cm wound, contralateral radius shaft, and ilium fractures. Following wound irrigation on the day of injury, second look debridement showed crushed triceps and severe contamination extending into the distal humerus medullary canal. After 6 days of initial plate fixation, he developed signs of deep infection. Radical debridement twice resulted in a 10-cm bone defect, necessitating reconstruction with a Lambda-shaped free vascularized fibula for both columns.</p><p><strong>Conclusion: </strong>Lambda-shaped column reconstruction using free vascularized fibula flap yields satisfactory clinical and radiographic outcomes in metaphyseal distal humerus bone defects.</p><p><strong>Level of evidence: </strong>V.</p><p><strong>Level of clinical care: </strong>Level I Tertiary trauma center.</p>","PeriodicalId":14748,"journal":{"name":"JBJS case connector","volume":"15 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS case connector","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.CC.24.00268","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Case: A 48-year-old man with multiple injuries sustained a Gustilo type 3A right open distal humerus fracture with a 4-cm wound, contralateral radius shaft, and ilium fractures. Following wound irrigation on the day of injury, second look debridement showed crushed triceps and severe contamination extending into the distal humerus medullary canal. After 6 days of initial plate fixation, he developed signs of deep infection. Radical debridement twice resulted in a 10-cm bone defect, necessitating reconstruction with a Lambda-shaped free vascularized fibula for both columns.
Conclusion: Lambda-shaped column reconstruction using free vascularized fibula flap yields satisfactory clinical and radiographic outcomes in metaphyseal distal humerus bone defects.
Level of evidence: V.
Level of clinical care: Level I Tertiary trauma center.
期刊介绍：
JBJS Case Connector helps improve patient care by providing the medical community with a journal that harnesses technology to provide information tools for discovery and reporting of unusual musculoskeletal problems, findings, treatment, and outcomes. Co-edited by Thomas W. Bauer, MD, PhD, and Ronald W. Lindsey, MD, JBJS Case Connector assists orthopaedic surgeons in the search for precedents, connections, and trends in their efforts to improve patient care. Using this unique journal, surgeons can find the commonalities between cases, benefit from the experience of their peers, and filter case information by many important variables in order to provide the best possible care for orthopaedic patients. This cross-referenced online journal includes thousands of orthopaedic case reports. It compiles symptoms, conditions, and demographic details to empower surgeons to find cases similar to theirs. Surgeons can mine the database to reveal emerging trends and identify patterns, distinguishing between truly rare cases and repeated, related single instances of a larger problem. The JBJS Case Connector Image Quiz feature provides interactive quizzes based on images from content published by JBJS and includes a discussion area for further exploration of ideas and concepts. The JBJS Image Quiz app for iPad and iPhone is available in the App Store. Contributions to JBJS Case Connector are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS ethics policies and all submissions to JBJS Case Connector are covered by the JBJS embargo policy.
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