Fig. 4.

A patient with gunshot injury of left elbow and forearm in Lebanon. (A) Extensive destruction of supracondylar humerus, olecranon and proximal radius with loss of function of radial and ulnar nerve. Primary treatment with external fixator, ESIN and K-wires. Humeral and radial nonunion after 11 months. (B) Revision humerus with removal of initial osteosynthesis, neurolysis (kinking of nervus radialis), debridement, cancellous bone from iliac crest, double plating (locked, radial and ulnar). Revision of the proximal radius with debridement, internal reduction and defect filling with cancellous bone from iliac crest. (B1: intraoperative situs, B2: radial and ulnar locking plate humerus, B3: radial defect filled with cancellous bone and stabilized with plate). (C) After 12 weeks consolidation radius, progredient consolidation humerus, range of motion 0°/5°/45° ext/flex, 30°/0°/15° pro-/supination. Active wrist extension above horizontal level.