Exceptional Complete Functional Recovery After Severe Multitissue Elbow Trauma in a Suicide Attempt Context: A Case Report

Abstract

Complex multitissue upper extremity trauma represents a major therapeutic challenge, particularly in an unfavorable psychiatric context. We report the case of a 33-year-old man admitted for self-inflicted elbow trauma combining complete brachial artery transection with acute ischemia, median nerve neurotmesis, distal biceps tendon rupture, and frontal cerebral contusion. Emergency multidisciplinary surgical management (four-hour delay) included brachial-to-brachial bypass using reversed saphenous vein, end-to-end nerve suture, and tendon repair. Initial assessment revealed complete median nerve palsy (thumb-index distal interphalangeal flexion 0/5, opposition 0/5) with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 78 and poor therapeutic compliance. A structured three-phase rehabilitation program over 12 months, combining physiotherapy, electrotherapy, and occupational therapy, achieved remarkable recovery demonstrated by near-normalized electrophysiological parameters (motor amplitude 3.2 mV, conduction velocity 69.6 m/s) and complete functional recovery with a final DASH score of 18. This exceptional case demonstrates that near-complete recovery is possible after severe nerve trauma, even in a suicide attempt context with unfavorable initial compliance, highlighting the crucial importance of optimal early surgical management and prolonged personalized physical medicine and rehabilitation program.