case_images: PMC11802259_01
case_images: Soft tissue injuries, posterior view. The trauma mechanism was torsional and with high-energy, posterior view. Cutaneous, subcutaneous muscular, adipose, endothelial, and endothelial involvement is observed.
case_images: cureus-0017-00000077107-i01.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i01.jpg
case_images: FIG1
case_images: A large wound was observed at the elbow and proximal third of the inner arm, with bone exposure at the elbow, edematous muscle tissue, and inadequate coverage, thus demonstrating that the trauma mechanism was torsional and high energy (Figures 1-2).
case_images: Soft tissue injuries, anterior view. The mechanism of high-energy torsional trauma with extensive soft tissue and bone damage is observed. Cutaneous, subcutaneous muscular, adipose, endothelial, and osseous involvement is observed.
case_images: cureus-0017-00000077107-i02.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i02.jpg
case_images: FIG2
case_images: A large wound was observed at the elbow and proximal third of the inner arm, with bone exposure at the elbow, edematous muscle tissue, and inadequate coverage, thus demonstrating that the trauma mechanism was torsional and high energy (Figures 1-2).
case_images: X-ray taken in the emergency room in the anteroposterior (AP) position. Diaphyseal fracture of the humerus with a third fragment and a long spiral fracture line was confirmed, with a fracture of both bones of the forearm, featuring a transverse fracture in the radius with significant displacement and a spiral fracture in the ulna.
case_images: cureus-0017-00000077107-i03.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i03.jpg
case_images: FIG3
case_images: IIIA open diaphyseal fracture of the humerus with a third fragment and a long spiral fracture line. In addition, both bones of the forearm were fractured, with a transverse fracture in the radius showing significant displacement and a spiral fracture in the ulna (Figure 3).
case_images: Postoperative X-rays in the anteroposterior (AP) and lateral views after damage control with external fixator stabilization. An acceptable reduction of the humeral bone injury and alignment of the forearm fractures was achieved, as shown in the postoperative X-ray in the AP view (Image A) and lateral view (Image B).
case_images: cureus-0017-00000077107-i04.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i04.jpg
case_images: FIG4
case_images: Postoperative X-rays demonstrated an acceptable reduction of the humeral bone injury and alignment of the forearm fractures (Figure 4), with optimal soft tissue management (Figure 5).
case_images: Postoperative optimal soft tissue management after damage control with external fixator stabilization. By placing an external fixator correctly, we can support the soft tissue. Cutaneous, subcutaneous, muscular tissue with good perfusion is observed. Coping points on the forearm help to prevent skin retraction.
case_images: cureus-0017-00000077107-i05.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i05.jpg
case_images: FIG5
case_images: Postoperative X-rays demonstrated an acceptable reduction of the humeral bone injury and alignment of the forearm fractures (Figure 4), with optimal soft tissue management (Figure 5).
case_images: Postoperative X-rays in the anteroposterior (AP) view showing the intramedullary titanium elastic nails (TENs). Acceptable fracture reductions are observed.
case_images: cureus-0017-00000077107-i06.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i06.jpg
case_images: FIG6
case_images: Seven days after the incident, the mini external fixator was replaced with fixation using two titanium elastic nails (TENs) through an intramedullary technique due to the fracture trace and the minimal incision required to be introduced, taking into account the state of the soft tissue (Figures 6, 7).
case_images: Post-surgical X-rays in the lateral view showing the intramedullary titanium elastic nails (TENs). Acceptable fracture reductions are observed.
case_images: cureus-0017-00000077107-i07.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i07.jpg
case_images: FIG7
case_images: Seven days after the incident, the mini external fixator was replaced with fixation using two titanium elastic nails (TENs) through an intramedullary technique due to the fracture trace and the minimal incision required to be introduced, taking into account the state of the soft tissue (Figures 6, 7).
case_images: Two-month postoperative follow-up from plastic and reconstructive surgery. The graft was found to be in good condition during the outpatient check-up.
case_images: cureus-0017-00000077107-i08.jpg
case_images: PMC11802259_01_cureus-0017-00000077107-i08.jpg
case_images: FIG8
case_images: At the two-month postoperative follow-up, the graft was in good condition (Figure 8).
case_images: PMC11802259_02
case_images: X-rays six months after surgery with titanium elastic nails (TENs), showing in the anteroposterior (AP) and lateral views . In image A, there is consolidation from the AP view, and in image B, there is consolidation from the lateral view.
case_images: cureus-0017-00000077107-i09.jpg
case_images: PMC11802259_02_cureus-0017-00000077107-i09.jpg
case_images: FIG9
case_images: Six months after the operation, X-rays show signs of fracture healing (Figure 9).
case_images: Good range of motion in the elbow has been observed. The patient can perform his daily activities. As seen in the image, he can perform full elbow extension (Image A) and flexion (Image B), although there is wrist drop due to radial nerve neuropraxia (Image B, green arrow), with limited pronation and supination.
case_images: cureus-0017-00000077107-i10.jpg
case_images: PMC11802259_02_cureus-0017-00000077107-i10.jpg
case_images: FIG10
case_images: The patient exhibited a good range of motion in the elbow, although wrist drop due to radial nerve neuropraxia was noted, with limited pronation and supination (Figure 10).