Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

Abstract

Background: Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results.

Materials: Our case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation.

Results: The average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities.

Conclusion: We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

Figure 1

Intraoperative photograph demonstrating lateral limb of osteotomy being performed through lateral approach.

Figure 2

Intraoperative photograph demonstrating medial limb of osteotomy being performed through medial approach.

Figure 3

V shaped osteotomy seen from lateral side with thin arrows showing the outline of V osteotomy and thick arrow showing the apex of the osteotomy in the humerus.

Figure 4

Bone model showing the v osteotomy.

Figure 5

Line diagram showing the osteotomy lines.

Figure 6

Postoperative lateral radiograph of 28 year female showing the well formed elbow joint(marked by thin black arrows) with unexcised static HO anteriorly (shown by thick black arrow) at 8 months follow up.

Figure 7

Postoperative antero-posterior radiograph of 28 year female showing the rectangle radiolucent joint line marked by thin black arrows at 80 months follow up.

Figure 8

Preoperative lateral and antero-posterior radiograph of 28 year Female demonstrating bony ankylosed elbow with matured HO anteriorly.

Figure 9

Clinical photograph of 28 year female showing the final extension at 80 months follow up.

Figure 10

Clinical photograph of 28 year female showing the final flexion at 80 months follow up.