Radiohumeral arthrodesis for salvage of failed total elbow arthroplasty

The fate of elbow arthrodesis: Indications, techniques, and outcome in fourteen patients

“…30 In this context, sound indications for EA exist: Severe posttraumatic arthrosis with ankylosis or instability; instability due to metastatic osteolysis; multiply operated patients with severe tissue loss and painful restricted ROM; chronically infected and failed reconstruction after osteosynthesis of elbow fractures, in cases with loss of function also at adjacent joints because of palsy of the muscles bridging the joint where orthoses and tendon transfers are not possible; severe open intraarticular fracture with extensive bone and softtissue loss; contraindicated or failed TEA; failed allografts; and complex war or gunshot injuries. 2,4,5,7,9,12,14,16,18,22,24,26,28,29,30,32,36,37 Extensive destruction of the elbow joint and poor softtissues with limitation of ROM 16 are good indications when other reconstructive surgeries, such as TEA, are contraindicated. Most often, EA offers pain relief; hence, if symptoms are intolerable pain, EA is worthwhile.…”

“…22,26 The fusion angle depends on whether working activities or selfcare are the functional goal and on the mobility of the contralateral arm. 22,26 Most authors have chosen 90-100 for fusion, 2,3,18,22,29,30,32,37 which enables the most powerful grip-strength. 2,12 In contrast, a fusion angle of 45 flexion seems to be more useful in assisting daily activities in some nondominant arms, 13,16,22,30 but personal hygiene and care cannot be performed.…”

“…24 Particularly in the multiply operated patient suffering from infection and posttraumatic arthritis, EA can relieve symptoms, maintain upper extremity function, and is the last resort when other surgical options are likely to produce complications or failure. 14,18,22,29,30 In 1977, Plank and Spier noted that with increasing enthusiasm for elbow arthroplasty, one should keep elbow arthrodesis in mind. 28 Only 3 series reporting the results of EA based on a representative sample size are available.…”

Radiohumeral arthrodesis with external fixation. A minimally invasive procedure for failed revision joint replacement of the elbow

“…External fixation has shown advantages over internal fixation in such scenario by avoiding the use of fixation directly into the infected area 18,19 The traditional Ilizarov approach provides simple compression of the osteotomy surfaces and this is eventually associated with periods of distraction to stimulate osteogenesis. 20 A further major advantage of external fixation is less soft tissue disruption with faster wound healing, which had to be considered in our diabetic and in the EA setting without bone grafting 9,6 . Both papers underlined ulnohumeral arthrodesis as the standard is the standard technique for elbow fusion due to the geometry and larger surface of the ulna respect to the radius and due to the possibility of maintaining supination and pronation of the forearm.…”

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AbstractElbow arthrodesis (EA) is a rare procedure to be performed and it is still considered a salvage approach to be chosen in selective cases only 5,9,10 . As reported by Koller it is one of the most difficult arthrodesis to perform for the surgeon with a high impact on the patients' quality of life 7.

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