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case_images: Initial AP and lateral x-rays views of the left elbow, showing an intraarticular intercondylar and supracondylar comminuted fracture.
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case_images: A 73-year-old man with hypertension and non-specified heart arrhythmia sustained, twenty months ago, a fall from a height of approximately eight steps with a direct blow over the left elbow causing severe pain, visual analogue scale 10/10, gross deformity, swelling, and disability of that arm (Figure 1). Serial surgical debridements were performed until we decided to remove the negative pressure assisted wound closure system and perform a pedicled antegrade PIA flap, to close the skin defect (Figure 6, Video 1).
case_images: Final AP and lateral postoperative x-rays after the distal humerus open reduction and internal fixation.
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case_images: The patient was diagnosed with an intercondylar and supracondylar fracture, and he was treated with an immediate ORIF with fragment specific medial and lateral plates, the approach was performed via an olecranon osteotomy fixated with a tension-band (Figure 2). Strength Scale. Skin scars were eutrophic, and the flap area showed euthermic, with capillary refill of two seconds, with no signs suggestive of infection (Figure 8, Videos 2 & 3).
case_images: Clinical aspect of the left elbow after the first visit to the office, beneath the active fistula a loosened screw was palpated.
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case_images: Physical examination revealed an open wound located in the posterolateral aspect of the elbow, of approximately 0.5 cm2 in size, with active non-fetid serous liquid drain (Figure 3), erythema, hyperthermia, swelling, limited range of motion at the elbow joint, along with pain at the superficial and deep palpation in the medial side of the elbow. Strength Scale. Skin scars were eutrophic, and the flap area showed euthermic, with capillary refill of two seconds, with no signs suggestive of infection (Figure 8, Videos 2 & 3).
case_images: From left to right, sequential x-rays showing the progressive hardware loosening, the previous surgeon decided to remove some of the screws of the lateral plate as shown in the AP and lateral of the far right. Above, AP views; below, lateral views.
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case_images: Strength Scale). The elbow joint was held in bending position with 90  of flexion, with active range of motion (ROM) of 100  of flexion and -80  of extension. Sequential x-rays revealed loosening of the fixation material, with osteolysis located in the distal humerus (Figure 4).
case_images: Free osteochondral fragment obtained during the second irrigation and debridement. The fragment is partially stained with methylrosanilinium chloride, used during the fistulography.
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case_images: Antibiotic-impregnated cement pearls were placed in the area formed after the joint and subchondral bone loss (Figure 5).
case_images: Above, left; defect remaining on the fistula site after the culture obtention and fistulography with methylrosanilinium chloride. Above, right; following the crystal violet staining a thoroughly fistulectomy was performed leaving a 3 x 4cm defect. Below, aspect of the elbow and forearm after the closure with an antegrade posterior interosseous artery flap.
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case_images: Serial surgical debridements were performed until we decided to remove the negative pressure assisted wound closure system and perform a pedicled antegrade PIA flap, to close the skin defect (Figure 6, Video 1).
case_images: Trans operative video after the antegrade posterior interosseous artery flap placement, good coloration and capillary refill are observed.
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case_images: Warsaw, IN, USA) prosthesis (Figure 7). We used this elbow system because at the current moment it is the only elbow replacement system available in our country.
case_images: Final AP and lateral postoperative x-rays after the cemented total elbow arthroplasty.
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case_images: Strength Scale. Skin scars were eutrophic, and the flap area showed euthermic, with capillary refill of two seconds, with no signs suggestive of infection (Figure 8, Videos 2 & 3).