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

Abstract

Elbow 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. This procedure is even more challenging when a massive bony defect occurs as it is the case after removal of a failed total elbow arthroplasty 4. Traditional EA is performed between the humerus and the ulna, due to the larger surface areas available, as reported by Staples, who described the employment of an olecranon wedge against the humerus 16 , or by Müller and Song, who suggested a plate compression between those two bones 7, 15 . The hypothesis whether a radiohumeral arthrodesis should be performed when the proximal ulna is completely absent due to reabsorption is based on anectodal evidence and few alternatives, as vascularized bone grafting, or renewed arthroplasty are available to the surgeon 6,9 . We present a case report of a 75 year old woman who had a history of multiple total elbow replacement failures with a massive ulnar bone loss in which a radiohumeral arthrodesis with external fixation was performed. Complete fusion was obtained with more than satisfactory results on the patient's quality of life.