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The Elbow More On The Elbow And The Arm
Discharge Summary

FINAL DIAGNOSES:

  1. Comminuted intra-articular fracture right distal humerus with extreme comminution of the radial aspect of the joint.
  2. Diabetes mellitus, diagnosed this admission.
  3. Elevated liver enzymes of uncertain etiology.
PERTINENT FINDINGS: This is a 33 year old white male who was jumping his motorcycle when he crashed. He sustained a significant injury to his right elbow with what appeared to be a T-condylar fracture with comminution, particularly posteriorly. He was splinted and routine lab work obtained. This man had an absolutely negative history for any significant problems except for facial trauma sustained in another motorcycle accident. However, his blood sugar was over 300, and his liver enzymes were significantly elevated.

Hepatitis screen was ordered which actually turned out to be negative. His HIV screen was also negative. He had a CT of his liver which showed no injury, and he always had a soft belly. The etiology of his liver enzymes is uncertain.

He was brought to surgery on the following day, on 02-03-97, where an ORIF was performed through a posterior Campbell-type approach. He was found to have a lot more comminution on the radial side of the joint, and it was apparent on his pre- operative films. I had hoped to get more rigid internal fixation, but because of the comminution, we were just simply unable to do so. A solitary screw was placed from medial to lateral, holding on the medial condyle and metaphyseal spike, and then three lateral-to-medial smooth K-wires were utilized. Pictures taken utilizing the C-arm intraoperatively showed good general position of all the fragments. He was splinted, and post-operatively, was managed as far as his pain was concerned. The day of discharge, I changed his splint. His wounds look fine without any evidence of infection,

I plan to see him in the office in approximately three weeks from the date of surgery. Because of his comminution intra-articularly, I am going to try to move him as soon as I can without having anything pull apart to try to get him some functional range-of-motion. I have already informed Mr. LaHatte and his Mother that the prognosis looks poor for normal elbow function. Certainly, limited goals and rehabilitation program will be in order; but we will try to get him moving earlier rather than later to prevent a lot of fibrosis.

I will see him on 02-24-97 in the office for splint removal and an x-ray.

For correspondence send email to lahatte@vicksburg.com.

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