gms | German Medical Science

Objectives/Interrogation: Elbow ankylosis is a predictable complication in severe complex trauma of the distal humerus or the proximal end of the ulna in which, in addition to stiffness, there is an important joint compromise but no prosthetic replacement is indicated. In young and motivated patients the recovery of the articulation can be restored with the interposition arthroplasties with ition of fascia lata.

The aim of the work is to report our experience of a series of five patients operated between the years 2009 and 2017 with this method.

Methods: Five patients were operated by means of elbow arthrolysis, posterior skin access with a deep medial access with epicondylar osteotomy and fascia lata interposition (age 35, 40, 50, and 45 years - 2 women 3 men). In two cases at the end of surgery and ligament reconstruction it was necessary to use the external fixator to protect the reconstruction permitting immediate active movement. In the remaining three cases the elbow had good residual stability and was not protected after surgery. The minimum follow-up was 2 year, the maximum of 9 years. Four times the operated side was the dominant side.

Regarding the etiology there were four post-traumatic cases and one post-coma. Ankylosis was present at 90 ° in 3 patients and at 80 and 70 ° in the others. Patients were evaluated with the mayo Elbow Performance Score MEPS. Once the fascia was harvested from a patient's triceps in all the others from tissue bank. Every time the fascia was folded on itself and secured by holes to the distal humerus. The principles of technique are shown in the presentation.

Results and Conclusions: The mean age was 43 years (range 36 to 59 years) at time of surgery. There were no major complications. In all patients a degree of satisfactory particularity was achieved without pain that allowed to bring the hand to the mouth in 4 cases and 5 cm from the face in the last case. There were no cases of secondary instability. The average extension deficit was 40 degrees (SD +/- 10). Two cases were classified as excellent (MEPS>80, two good (MEPS>60) and one fair (MEPS > 40).

Elbow interposition arthroplasty with fascia lata or tricipital fascia is a valid alternative in patients with severe functional limitation who have no indication for an elbow prosthesis (young, active patients). The addition of distraction and external fixation, in conjunction with ligament reconstruction, has addressed the instability problem and therefore improved results.