elbow ankylosis: treatment by fascia lata …fessh2018.com/posterview/posterlist/down/a-0603.pdf ·...

Pierluigi Tos 1 , Simona Odella 1 , Bruno Battiston 2 , Federico Palumbo 1 , Sara Razza 1 INTRODUCTION Elbow ankylosis is a predictable complication in severe complex traumas of distal humerus and of the proximal radius and ulna in which, in addition to rigidity, there is an important joint impairment but no prosthetic replacement is indicated. In young and motivated patients, the retrieval of range of motion can be restored by fascia lata interposition arthroplasty. (1) The purpose of the work is to bring our experience of a case study of five patients who had surgery between 2009 and 2016 with this method. Fig 1 post traumatic important joint impairment ELBOW ANKYLOSIS: TREATMENT BY FASCIA LATA INTERPOSITION ARTHROPLASTY RESULTS There were no major complications. In all patients, a degree of satisfactory, pain-free range of motion was achieved; patients could lead the hand to the mouth in four 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 MEPS score) and two as discreet (70 MEPS score); the ROM were between 50 and 100 degres. Tab 1 CONCLUSION Arthroplasty of the elbow with fascia lata or triceps band interposition is a viable alternative in those patients with severe functional limitations that have no indication for an elbow prosthesis. The loss of movement of this joint is poorly tolerated and constitutes an important functional impairment for a young patients. Fig 2 man 40 years old, post traumatic important joint impairment after 9 months, fascia lata interposition arthroplasty, x ray results after 6 months and clinical results Bibliography R Sivakumar,1 V SomaSheker,1 Prahalad Kumar Shingi,1 T Vinoth,1 and M Chidambaram1 Treatment of Stiff Elbow in Young Patients with Interpositional Arthroplasty for Mobility: Case Series. J Orthop case report, 6(4): 49-52; 2016 METHODS Five patients had surgery: we performed arthrolysis using a medial access performing epitroclea osteotomy and fascia lata interposition in four cases (age 35, 40, 50 and 60 years - 2 women and 2 men) in one case, 50 years old, a posterior access was performed. In three cases at the end of surgery and legaments reconstruction, the use of the external fixator was necessary, while in two cases the elbow had good residual stability and were not protected. The minimum follow-up was 8 months, the maximum 8 years. Twice the affected side was the dominant one. As for etiology, there were four post-traumatic cases and one post coma. The ankylosis was present at 90 ° in three patients and at 80 in one and 100° in the other case. Patients were evaluated with MEPS. Once the fascia lata was an autograft from the triceps of the patient. The other four times from bank tissue and folded on herself. Fig 2 pz PREOP FLEST / PRONOSUP POSTOP FLEST / PRONOSUP DOLORE / INSTABILITA’ FU FISS EXT 1M 50aa Postrumatic o/coma 80-80-80 0-0-0 140-20 90-0-90 NO/NO FU 5 aa FEA 2F 35aa postruamati co 90-90-90 0-0-0 100-30 90-0-90 NO/NO FU 8 aa FEA 3F 60aa postrumatic o 90-90 70-0-80 120-50 70-0-80 NO/NO FU 4 aa FEA 4M 40aa postruamati co 80-90 40-0-20 100-30 50-0-40 NO/NO FU 1-1/2 aa / 5M 50aa postrumatic o 100-110 90-0-90 130-40 90-0-90 NO/NO FU 1 aa / 1 Asst pini-cto, UOC Hand Surgery and Reconstructive Microsurgery Milan, 2 AOU City of Health and Science of Turin UO Orthopedics and Traumatology 2 Hand Surgery

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Page 1: ELBOW ANKYLOSIS: TREATMENT BY FASCIA LATA …fessh2018.com/posterview/posterlist/down/A-0603.pdf · score) and two as discreet (70 MEPS score); the ROM were between 50 and 100 degres

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