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We report a case of an elbow arthrodesis using a modular hinged external fixation device in a patient who sustained a complex high-energy injury. The extensive bone and soft-tissue loss and local infection precluded restoration of the articular anatomy. Other reconstructive options, including total elbow arthroplasty and allograft reconstruction, were not appropriate in this clinical situation. A transelbow hinged external fixator was applied with the elbow in extension. Subsequently, the hinge was brought gradually into 90 degrees of flexion as the elbow fused. Fixation and arthrodesis were successfully achieved by using this modular device, despite severe tissue loss and local septic complications. Furthermore, by gradually flexing the frame from full extension to 90 degrees , the need for flap coverage of the open wound was avoided.

We are reporting herein the result of a 22 cm tibial lengthening after using an acute shortening technique with acute temporary angulation for salvage of a posttraumatic lower limb injury. The patient was referred to our center 2 weeks after a Gustilo IIIB open complex injury to the lower limb that included bone and soft-tissue loss. After surgical debridement, the tibial gap was 22 cm and the soft-tissue defect on the anterior aspect of the calf measured 12 x 20 cm. An acute shortening using a 50 degrees angulation (apex posteriorly) of the tibia in an Ilizarov frame was done after a full assessment of all reconstructive surgical options. After complete wound healing, a progressive correction of the angulation was done. Bilevel tibial distraction at a rate of 1.75 mm/day restored the original lower limb length. The 22 cm tibial elongation included 17 cm proximal lengthening and 5 cm distal lengthening. The fractures consolidated after 371 days, all wounds had closed, and no signs of osteomyelitis were present. Good aesthetic and functional results were obtained. The patient had no leg discrepancy compared to his normal limb and he returned to his previous occupation as a garage mechanic and to his favorite sport, boxing. To our knowledge, this is the first report in the English literature of tibial lengthening of this magnitude following acute trauma.

Because of their complexity, war injuries inflicted by a blast mechanism often require tailoring of treatment to attain a more individualized solution. We report two cases of bilateral, severely mangled lower limbs with open tibial fractures and crush injuries to the feet. In each case, one limb had to be amputated below the knee, but the other limb was saved by immediate stabilization in a tubular external fixation frame crossing the knee; the frame was later replaced by a hybrid ring fixation frame with a freely moving knee. Such incidences are rare, and the particular management detailed here has not previously been reported in the literature.