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HISTORY OF PRESENT ILLNESS The patient is a 56-year-old right-hand-dominant male status post MVA sustaining a left open supracondylar humerus fracture treated with irrigation and debridement and open reduction and internal fixation with synthetic bone grafting done at that time He also had a splenic injury and a left acetabular fracture He was initially treated for his left humerus fracture His postoperative course was complicated by a draining wound He was transferred where he came under the care of Dr Jones to fix his left acetabular fracture Followup x-rays of his humerus revealed that he had a nonunionmalunion with hardware failure and was referred here for further management In the interim he denies any fevers or chills He denies any sweats or weight lossALLERGIES He has no known drug allergies PAST SURGICAL HISTORY His past surgical history is significant for left acetabular fracture ORIF MEDICATIONS No medications SOCIAL HISTORY He is an engineer He does not use tobacco He has no ETOH He likes fishing swimming and golfPHYSICAL EXAMINATION On physical examination of his left elbow there is a well heeled posterior incision It is warm to touch compared to the right side There is obvious deformity with swelling He has intact sensation of the ulnar nerve distribution distally although he does have a positive Tinels test in the ulnar nerve which radiates down into his small finger He has full digital range of motion The motion of his elbow is 70 to 90 degrees with 10 degrees of pronation and 40 degrees of supination His abductor digitus minimi and finger abductors are -45 STUDIES x-rays reviewed from an outside hospital show a malunionnonunion of his left supracondylar humerus fracture with fracture collapse and hardware failureASSESSMENT Left supracondylar humerus fracture nonunionmalunion with questionable infectionPLAN1The patient was seen and examined by Dr Smith as well as Dr Jones2We discussed in detail the management of this problem and the difficulty as we feel that this fracture is
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