Die Arthrodese der oberen Extremitätengelenke im Rahmen der Behandlung infizierter Frakturen und Pseudarthrosen

The fate of elbow arthrodesis: Indications, techniques, and outcome in fourteen patients

“…30 In this context, sound indications for EA exist: Severe posttraumatic arthrosis with ankylosis or instability; instability due to metastatic osteolysis; multiply operated patients with severe tissue loss and painful restricted ROM; chronically infected and failed reconstruction after osteosynthesis of elbow fractures, in cases with loss of function also at adjacent joints because of palsy of the muscles bridging the joint where orthoses and tendon transfers are not possible; severe open intraarticular fracture with extensive bone and softtissue loss; contraindicated or failed TEA; failed allografts; and complex war or gunshot injuries. 2,4,5,7,9,12,14,16,18,22,24,26,28,29,30,32,36,37 Extensive destruction of the elbow joint and poor softtissues with limitation of ROM 16 are good indications when other reconstructive surgeries, such as TEA, are contraindicated. Most often, EA offers pain relief; hence, if symptoms are intolerable pain, EA is worthwhile.…”

“…Several series used various external and internal surgical techniques. 12,14,16,24 Most authors report on the frequent need for additional procedures, mainly for nonunions, 2,13,27,36 bone graft fractures or their resorption, 13,22,36 persistent infections, 13,22,24,36 implant removal, 2,22 , and soft-tissue complications because of skin-breakdown and scarring. 22,24 .…”

“…2,30 It is advisable to immobilize the patient's elbow in the desired position prior to definitive EA, including time at work. 12,14,25,30 For patients with both elbow joints involved, arthoplasty or resection of at least 1 elbow is recommended. 2 In bilateral EA, the fusion angles are beyond 90 (110-120 ) for dominant arms and less than 90 (40-65 ) for the other.…”

“…24 Particularly in the multiply operated patient suffering from infection and posttraumatic arthritis, EA can relieve symptoms, maintain upper extremity function, and is the last resort when other surgical options are likely to produce complications or failure. 14,18,22,29,30 In 1977, Plank and Spier noted that with increasing enthusiasm for elbow arthroplasty, one should keep elbow arthrodesis in mind. 28 Only 3 series reporting the results of EA based on a representative sample size are available.…”