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