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. 2015 Dec 8;44(4):336-41.
doi: 10.1016/S2255-4971(15)30163-4. eCollection 2009 Jan.

STIFF ELBOW TREATMENT BY INTERPOSING ARTHROPLASTY ASSOCIATED TO HINGED EXTERNAL FIXATOR

Alberto Naoki Miyazaki  1 , Marcelo Fregoneze  2 , Pedro Doneux Santos  2 , Luciana Andrade da Silva  2 , Nelson Gennaro Junior  3 , Sergio Luiz Checchia  4
Affiliations

STIFF ELBOW TREATMENT BY INTERPOSING ARTHROPLASTY ASSOCIATED TO HINGED EXTERNAL FIXATOR

Alberto Naoki Miyazaki et al. Rev Bras Ortop. .

Abstract

Objective: Assess the results of the elbow/fascia lata interposing arthroplasty technique associated to the use of a hinged external fixator in the treatment of stiff elbow.

Methods: Between 2001 and 2006, five cases of stiff elbow were operated and followed up by the Shoulder and Elbow Group of the Santa Casa Misericórdia de São Paulo Medical Sciences School, establishing the following as inclusion criteria: patients with below-functional elbow range of motion associated to degeneration on that joint, for whom total prosthesis had not been indicated. Patients' ages ranged from 21 to 55 years (mean: 38). Male gender was prevalent (four cases), and, in all cases, the dominant side was operated. Concerning etiology, two cases of infectious arthritis sequels, one post-trauma sequel, and two rheumatoid arthritis were found. Preoperative range of motion ranged from 20° to 30° of flexion-extension; in two cases, fixed contracture existed in flexion at 30° and 65°. The patients were assessed according to Bruce-modified AMA criteria.

Results: The mean follow up time was 54 months. All patients showed improvement of the Bruce index, which, preoperatively, was 43.5, increasing to 88.2 postoperatively. We found two excellent cases, one good, one fair, and one poor.

Conclusion: Fascia lata interposing arthroplasty associated to the use of a dynamic external fixator on stiff elbows is a feasible alternative for patients not indicated to total elbow arthroplasty.

Keywords: Arthoplasty; Elbow joint; External fixators; Range of motion, articular.

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Figures

Figure 1
Figure 1
Intraoperative images: (a) posterior approach passage with isolation of the triceps tendon, folded to the side, (b) osteotomy performed at the site of the joint interline (arrow), (c) posterior view of the distal humerus
Figure 2
Figure 2
Intraoperative images: (a) lateral approach passage of the thigh with fascia lata isolation, (b) image of ± 15 by 4.0 cm fascia lata, (c) covering of the distal humerus with the fascia, fixed through transosseous sutures, (d) final view with the elbow reduced
Figure 3
Figure 3
Case 4-X-ray images of the elbow in the immediate postoperative period with an external fixator: (a) front view, (b) profile view
Figure 4
Figure 4
Case 4-Frontal and lateral radiographic images of the affected elbow preoperatively (a, b) and one year post-surgery (c, d). Patient's current mobility in maximum extension (e) and flexion (f)
See this image and copyright information in PMC

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