Surgical Management of Neglected Elbow Fracture-Dislocation: The Role of Soft Tissue Interposition Arthroplasty

Abstract

Background: Neglected elbow fracture-dislocations are uncommon but clinically challenging injuries associated with pain, deformity, stiffness, periarticular fibrosis, heterotopic ossification, and articular damage. When anatomical reconstruction or prosthetic replacement is not feasible, soft tissue interposition arthroplasty may be considered as a salvage option. Case Presentation: A 59-year-old right-hand-dominant woman presented with persistent right elbow pain, progressive deformity, and severe movement restriction four months after a fall onto her right elbow while collecting firewood. She had initially undergone several manipulation sessions with a traditional bonesetter before referral to a tertiary orthopaedic centre. Clinical examination demonstrated swelling, angular deformity, diffuse tenderness, severely limited elbow movement, preserved wrist and finger motion, and intact distal neurovascular status. Radiographs and three-dimensional computed tomography confirmed a neglected closed fracture-dislocation with radial head and coronoid comminution, loss of joint congruence, heterotopic ossification, and secondary degenerative change. Management and Outcome: Because chronic fibrosis, comminution, articular destruction, financial constraints, and implant availability made anatomical reconstruction and total elbow arthroplasty unsuitable, autologous fascia lata interposition arthroplasty was performed. Postoperative management included short-term immobilisation, indomethacin prophylaxis, active-assisted physiotherapy, and dynamic splinting. At 12 weeks, pain control, elbow motion, and light daily activity performance had improved. Conclusion: This case highlights the consequences of delayed care and supports selected use of soft tissue interposition arthroplasty as a bone-preserving salvage approach in neglected elbow fracture-dislocation.