PierluigiTos1,SimonaOdella1,BrunoBattiston2,FedericoPalumbo1,SaraRazza1

INTRODUCTIONElbow ankylosis is a predictable complication in severe complex traumas ofdistal humerus and of the proximal radius and ulna in which, in addition torigidity,thereisanimportantjointimpairmentbutnoprostheticreplacementisindicated.Inyoungandmotivatedpatients,theretrievalofrangeofmotioncanberestoredbyfascialatainterpositionarthroplasty.(1)Thepurposeoftheworkistobringourexperienceofacasestudyoffivepatientswhohadsurgerybetween2009and2016withthismethod.

Fig1posttraumaticimportantjointimpairment

ELBOWANKYLOSIS:TREATMENTBYFASCIALATAINTERPOSITIONARTHROPLASTY

RESULTSTherewere nomajor complications. In all patients, adegreeof satisfactory, pain-free rangeofmotionwasachieved;patientscouldleadthehandtothemouthinfour cases and 5 cm from the face in the last case.There have been no cases of secondary instability.Three cases have been classified as good (80 MEPSscore)and twoasdiscreet (70MEPSscore); theROMwerebetween50and100degres.Tab1

CONCLUSIONArthroplasty of the elbow with fascia lata or triceps band interposition is a viable alternative in thosepatients with severe functional limitations that have no indication for an elbow prosthesis. The loss ofmovementofthisjointispoorlytoleratedandconstitutesanimportantfunctionalimpairmentforayoungpatients.

Fig2man40yearsold,posttraumaticimportantjointimpairmentafter9months,fascialatainterpositionarthroplasty,xrayresultsafter6monthsandclinicalresults

BibliographyRSivakumar,1VSomaSheker,1PrahaladKumarShingi,1TVinoth,1andMChidambaram1TreatmentofStiffElbowinYoungPatientswithInterpositional

ArthroplastyforMobility:CaseSeries.JOrthopcasereport,6(4):49-52;2016

METHODSFivepatientshadsurgery:weperformedarthrolysisusingamedial access performing epitroclea osteotomy and fascialatainterpositioninfourcases(age35,40,50and60years-2womenand2men)inonecase,50yearsold,aposterioraccesswasperformed.Inthreecasesattheendofsurgeryand legaments reconstruction, the use of the externalfixator was necessary, while in two cases the elbow hadgood residual stability and were not protected. Theminimum follow-upwas 8months, themaximum 8 years.Twice the affected side was the dominant one. As foretiology,therewerefourpost-traumaticcasesandonepostcoma. The ankylosiswas present at 90 ° in three patientsandat80 inoneand100° intheothercase.PatientswereevaluatedwithMEPS.Oncethefascialatawasanautograftfrom the tricepsof thepatient. Theother four times frombanktissueandfoldedonherself.Fig2

pz PREOPFLEST/PRONOSUP

POSTOPFLEST/PRONOSUP

DOLORE/INSTABILITA’

FU FISSEXT

1M50aa

Postrumatico/coma 80-80-800-0-0 140-2090-0-90 NO/NO FU5aa FEA

2F35aa

postruamatico 90-90-900-0-0 100-3090-0-90 NO/NO FU8aa FEA

3F60aa

postrumatico 90-9070-0-80 120-5070-0-80 NO/NO FU4aa FEA

4M40aa

postruamatico 80-9040-0-20 100-3050-0-40 NO/NO FU1-1/2

aa/

5M50aa

postrumatico 100-11090-0-90 130-4090-0-90 NO/NO FU1aa /

1Asstpini-cto,UOCHandSurgeryandReconstructiveMicrosurgeryMilan,2AOUCityofHealthandScienceofTurinUOOrthopedicsandTraumatology2HandSurgery