RESUMEN
INTRODUCTION: Total elbow arthroplasty (TEA) is a viable treatment for pain-free mobility in stiff elbow of sedentary patients with rheumatoid arthritis and ankylosis. Secondarily, TEA is useful in cases of stiff failed fixation and bone loss of distal humerus fractures. CASE REPORT: A Fifty one years old sedentary male presented to our institute with a history of injury to the right elbow (sideswipe injury). On clinical and radiological examination, it was open Grade III B fracture of distal humerus with bone loss. He was treated with wound debridement and initial temporary fixation with k-wires and later soft-tissue reconstruction. One year later, the patient upper limb was flail, limited range of motion (passive 40° 70°) and no infection. Radiology revealed non-union of condylar fragments with bone loss of distal humerus. The patient underwent TEA through standard triceps reflecting approach. He was implanted cemented modular Coonrad-Murray semi-constrained prosthesis Type III. The post-operative period was uneventful. At 4-year follow-up, the patient is pain free with elbow range of motion 5°120°. CONCLUSION: In failed osteosynthesis and sedentary patients, TEA is a SALVAGE surgery for pain-free mobility with its own long-term limitations.
RESUMEN
INTRODUCTION: The elbow is a complex joint involving many articulations and complex biomechanics come into play. Elbow motion is crucial to upper limb movement that loss of 50% of elbow function equals to loss of 80% of upper extremity global function. Restoring movement and stability is challenging to the surgeon while treating a stiff elbow. Unlike other arthroplasties of hip and knee, total elbow arthroplasty (TEA) may not be a primary treatment. Interpositional arthroplasty (IPA) can be considered a viable option in posttraumatic arthritis of elbow in young patients. CASE REPORT: We report two cases of interpositional arthroplasties done in young patients secondary to posttraumatic event. The first case is 22-year-old female with a history of stiff elbow following a posttraumatic event 3 years back and the second case is 24-year-old male laborer with stiff elbow following trauma more the 10 years back for which he took native treatment. In both the cases through posterior approach to the elbow, we did osteolysis and prepared fascia lata grafts are interpositioned over the recreated articular surfaces. Both the patients in the follow-up have a good range of motion, stability and are satisfied. CONCLUSION: IPA is a good treatment option in young patients with posttraumatic arthritis. Elbow instability, fascia rupture, thigh pain, and hernia are the problems of IPA. IPA to TEA transition is possible.