Open fractures may occur due to high energy mechanisms or in the presence of a fragile soft-tissue envelope around the elbow, such as in elderly patients.
Be aware of a higher incidence of neurovascular injuries and associated bony or other system polytrauma.
Neurovascular injuries need urgent assessment and management. The treatment options, including operative approach, type of fracture fixation, and surgical management, are determined by the neurovascular state. In polytraumatized patients, the management of the elbow fracture is subordinate to the overall resuscitation of the patient and may be delayed. In this situation, temporary fixation of the limb in anatomic alignment (splinting or external fixation) may help protect the soft tissues until definitive treatment is possible. Frequent and regular observations of neurovascular status are mandatory.
The gold-standard treatment is early debridement, intravenous antibiotics, bony stabilization, and soft-tissue management. A combined orthoplastics approach can be helpful.
A staged approach may be optimal. This includes initial soft-tissue and bony debridement, temporary skeletal stabilization (external fixation) followed by serial debridements, and definitive fixation when soft-tissue coverage is possible. Vacuum-assisted wound management may be helpful.
Restoration of perfusion of the forearm and hand should take priority: vascular repair or bypass should be performed primarily after emergency stabilization of the elbow region using external fixation.
Damaged nerves should be tagged for later identification and repair during subsequent procedures.