Surgical release for tubercular elbow stiffness

Abstract

BackgroundFor decades, tuberculosis (TB) has posed a great threat to people worldwide. Bone and joint TB is one of the most common types of extrapulmonary TB, with elbow TB comprising a small proportion of these cases. The treatment for elbow stiffness associated with TB has been rarely reported.Patients and methodsWe retrospectively analyzed six patients (four females and two males) with tubercular elbow stiffness during a 7-year period. All of them received open arthrolysis and hinged external fixation to restore functional extension, flexion, supination and pronation. Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were evaluated preoperatively and at final follow-up.ResultsAt final follow-up after surgery, we evaluated the average active ROM, which was 111.7° (90°–135°). The average extension was 11.7° (0°–30°), while the average flexion was 123.3° (115°–135°). At the same time, the average supination was increased to 70° (40°–90°) and the average pronation was increased to 68.3° (45°–80°). The MEPS was elevated to 92.5 (85–100). Three patients displayed complications and were treated and cured with dressing changes and antibiotics.ConclusionOpen arthrolysis and hinged external fixation are useful for the treatment of non-traumatic elbow stiffness with TB.

Characteristics and management of bone and joint tuberculosis in native and migrant population in Shanghai during 2011 to 2015

“…For spine TB patients, spinal fusion was adopted for reconstruction of stable joints via a direct lateral interbody fusion manner using minimal invasive operations. For those who experienced stiff joint and limitations in activity, joint arthrolysis was carried out basically including capsule release, muscle and tendon repair as well as bone reconstruction [ 8 ].Biopsy of bone or soft tissue was conducted in partial patients.…”