Treatment of post-traumatic complete bony ankylosed elbow using total arthroplasty and hernia patch - A case report

Abstract

Introduction and importance: The elbow is one of the most mobile joints, and its movement is very important. Bony ankylosed elbow is an uncommon condition leading to complete loss of activity of elbow, and then lead to severe disability and limitation in activities of daily living.

Case presentation: A 63-year-old woman sustained comminuted fracture of left distal humerus. She underwent open reduction and internal fixation by plates. After the plates were removed in 2016，stiffness developed.The elbow was stable but fixed at 90°，there was no vascular injury or deficit in sensory and motor function of the ulnar nerve. She hopes to eliminate pain and restore normal mobility compatible with ADL.

Clinical discussion: Complete bony ankylosis of the elbow joint may be caused by trauma, rheumatic disease, burns, congenital stiffness and other conditions. Even with the compensation of shoulder and wrist, it will still have a great impact on upper limb function. Whether to treat mainly depends on whether the patient has the require to improve the functionality and return to daily activities. Treatment methods are very limited, including interposition arthroplasty and TEA. Defect of soft tissue appeared was seen in our case, Hernia Patch was innovatively applied to reconstruct the defect of soft tissue and maintain continuity of elbow extension mechanism.

Conclusion: Patients with post-traumatic elbow joint ankylosis were suffered from severe bony abnormalities, but also soft tissue contracture or defects due to multiple operations and trauma. We present a case of complete bony ankylosed elbow treated with total elbow arthroplasty and Hernia Patch.

Keywords: Ankylosed elbow; Hernia patch; Post-traumatic; Total arthroplasty.

Fig. 1

The elbow was fixed at 90°, and the arc of forearm pronosupination was 30°.

Fig. 2

There was no vascular injury or deficit in sensory and motor function of the ulnar nerve.

Fig. 3

X-ray of left elbow revealed the humeroulnar joint was complete bony fused at 90° flexed position.

Fig. 4

The ulnar nerve was carefully exposed and protected.

Fig. 5

Then triceps muscle, forearm fascia and the osteotomy block were retracted laterally to expose the bony fused humeroulnar joint.

Fig. 6

The lateral part of the osteophyte was removed to expose the capitulum radius which was a standard for reconstruction of the original humeroulnar joint line.

Fig. 7

The capitulum radius was not removed in this case. The humeroulnar joint was opened using a micro-sagittal saw and small osteotome.

Fig. 8

The elbow was flexed and rotated externally to expose the distal humerus and proximal ulna.

Fig. 9

The humerus and ulna medullary canal were prepared according to the Coonrad/Morrey Elbow System specifications, then a trial reduction was performed.

Fig. 10

The range of motion was checked, and it should be noted that there was no impinge during flexion and extension.

Fig. 11

Intraoperative fluoroscopy showed that the prosthesis was in good position.

Fig. 12

The prosthesis cannot be completely covered due to contracture.

Fig. 13

The Hernia Patch was used.

Fig. 14

Postoperative X-rays showed a correct alignment of the components.

Fig. 15

At one year follow-up, the active arc of movement of the elbow was 140°, from 0° of extension to 140° of flexion, and pronosupination was as same as the right side.

Fig. 16

One year after operation, the X-rays showed that all the components were fine without any defect.