Arch Hand Microsurg.  2017 Dec;22(4):261-267. 10.12790/ahm.2017.22.4.261.

Reconstruction of an Ulnohumeral Joint in a Young Patient with Iatrogenic Joint Fusion: A Case Report

• Lee CH
• Oh HK
• Lee BG
• Lee KH

• KMID: 2406130
• DOI: http://doi.org/10.12790/ahm.2017.22.4.261

Abstract

Elbow arthrodesis is a predictable salvage surgery for advanced elbow joint disease. However, iatrogenic joint fusion impaired activity of daily living. In the presented case, a young woman suffered from an iatrogenic joint fusion which developed after several surgeries for comminuted intercondylar fracture of distal humerus. We tried to reconstruct the ulnohumeral joint, as she was too young to have a total elbow arthroplasty. Finally, she regained the motion of elbow and satisfied with the clinical outcome after two consecutive operations. We described the process of recovery and summarized the pearls and pitfalls.

Keyword

Reconstruction; Ulnohumeral joint; Iatrogenic joint fusion

MeSH Terms

Arthrodesis
Arthroplasty
Elbow
Elbow Joint
Female
Humans
Humerus
Joints*

Figure

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  Fig. 1 (A, B) Plain radiographs showed the fused elbow with a retained wire. (C–F) Sagittal and 3-dimensional images of the computed tomography scan showed the bony fusion of ulnohumeral joint.

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  Fig. 2 Inaccurate reduction of articular fragments and inappropriate fixation with 3 K-wires were found after initial operation.

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  Fig. 3 Multiple pinning with K-wires was done through trans-olecranon approach at second operation.

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  Fig. 4 Three Steinmann pins were placed to treat the delayed union and false motion at fracture site.

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  Fig. 5 Plain radiograph showed indistinct and narrow joint space 4 months after reconstruction of ulnohumeral joint.

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  Fig. 6 She regained satisfactory motion of right elbow at final follow-up (A, B) and plain radiograph (C, D) also showed clear space of ulnohumeral joint.

Reference

1. Otto RJ, Mulieri PJ, Cottrell BJ, Mighell MA. Arthrodesis for failed total elbow arthroplasty with deep infection. J Shoulder Elbow Surg. 2014; 23:302–307.

2. Koller H, Kolb K, Assuncao A, Kolb W, Holz U. The fate of elbow arthrodesis: indications, techniques, and outcome in fourteen patients. J Shoulder Elbow Surg. 2008; 17:293–306.

3. Hintermann B, Barg A, Knupp M, Valderrabano V. Conversion of painful ankle arthrodesis to total ankle arthroplasty. J Bone Joint Surg Am. 2009; 91:850–858.

4. Sperling JW, Cofield RH. Total shoulder arthroplasty after attempted shoulder arthrodesis: report of three cases. J Shoulder Elbow Surg. 2003; 12:302–305.

5. Burkhart KJ, Dargel J, Wegmann K, Müller LP. Conversion of elbow arthrodesis to total elbow arthroplasty. Unfallchirurg. 2013; 116:371–375.

6. Mansat P, Bonnevialle N, Rongières M, Mansat M, Bonnevialle P. French Society for Shoulder and Elbow SOFEC. Results with a minimum of 10 years follow-up of the Coonrad/Morrey total elbow arthroplasty. Orthop Traumatol Surg Res. 2013; 99:S337–S343.

7. Park SE, Kim JY, Cho SW, Rhee SK, Kwon SY. Complications and revision rate compared by type of total elbow arthroplasty. J Shoulder Elbow Surg. 2013; 22:1121–1127.

8. Hohman DW, Nodzo SR, Qvick LM, Duquin TR, Paterson PP. Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries. J Shoulder Elbow Surg. 2014; 23:265–272.

9. Erşen A, Demirhan M, Atalar AC, Salduz A, Tunalı O. Stiff elbow: distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthop Traumatol Turc. 2014; 48:558–562.

10. Ring D, Jupiter JB. Operative release of complete ankylosis of the elbow due to heterotopic bone in patients without severe injury of the central nervous system. J Bone Joint Surg Am. 2003; 85-A:849–857.