陈旧性肱骨远端复杂性骨折的人工肘关节置换

[目的]研究人工肘关节置换治疗陈旧性复杂性肱骨远端骨折的疗效.[方法] 1998年1月～2008年12月对14例陈旧性肱骨远端复杂性骨折置换人工肘关节14例进行随访,患者平均59.2岁,平均随访时间为8.4年.原骨折按AO分型,C2型4例,C3型10例.假体关节为Coonrad-Morrey半限制性假体.对术前后疼痛、关节活动度、稳定性、肌力和并发症等作为重点,经由Mayo肘关节评价、DASH评价、影像学评价有无假体松动和异位骨化等.[结果]4例在强度屈肘时轻度疼痛,本组肘关节平均屈曲112.6°(0°～144°),平均伸肘7.9°,屈124°,术后平均伸直受限22°.术后平均旋前79.8°,旋后78.2°.14例肘关节稳定,患者对治疗结果满意.并发术中内侧柱骨折、尺神经麻痹和异位骨化各1例.无假体松动.Mayo肘关节评价优(＞90分)7例,良(75～ 89分)7例.DASH评价平均48.2分(24.4～78分).[结论]人工肘关节置换治疗陈旧性肱骨远端复杂骨折畸形愈合或创伤性关节炎患者,是一种疗效肯定的治疗手段.     

人工肘关节置换术治疗炎症性肘关节炎的临床效果及相关分析(英文)

目的对应用Souter-Strathclyde假体行肘关节置换术治疗炎症性肘关节炎的的临床效果进行分析。方法1993至2000年间,共49例患者(51肘)在芬兰坦配雷大学医学院医院应用Souter-Strathclyde假体行全肘关节置换术。其中女43例,男16例,平均年龄61.7岁(31～78岁),临床评估参照Ewald评分系统。结果除1例患肘是牛皮癣性肘关节炎外,其余均为风湿性肘关节炎,平均病程为30年(10～43年),Larsen分级术前4级22肘,5级29肘,47肘应用非限制型Souter-Strathclyde假体,4肘应用半限制型假体。平均随访时间72个月(0.5～114个月)。所有患者最终随访时的肘关节功能得到明显提高,平均活动度由术前的伸32.8°-屈126.9°提高至伸25.2°-屈145.0°(P0.05);Ewald评分由术前的平均46.7分提高至95.0分(P0.05)。2例患者出现术后关节脱位,1例手术复位,另1例闭合复位后石膏固定;另外有1例患者因肱三头肌撕裂进行了手术修复;3例肱骨及桡骨假体周围出现骨吸收线。以再次翻修作为终点,假体5年生存率为98%,8年生存率为93%,临床功能优良率为95.5%。结论尽管炎症性关节炎会导致患者韧带松弛,容易感染,骨质破坏,一般情况较差,但是全肘关节置换术可以为炎症性肘关节炎患者带来良好的临床疗效。     

关节清理术治疗原发性肘骨关节炎的近远期疗效比较

目的比较分析肘关节清理术治疗原发性肘关节炎的近、远期疗效。方法对10例（11肘）中、重度原发性肘骨关节炎患者,采用Kocher外侧切口清除肘关节骨赘、骨嵴及游离体,合并肘管综合征者同时行尺神经松解前移术,观察肘关节活动度及疼痛改善情况。结果术后6～22个月,肘关节活动度平均增加伸10°、屈17°,疼痛由2～3级缓解为0～1级达72．7％（8／11）。术后8～10年,肘关节活动度平均减少伸8°、屈13°;疼痛2～3级达81．8％（9／11）,并可见骨赘复发。结论肘关节清理术治疗原发性骨关节炎的近期疗效虽较满意,但远期疗效不理想,目前可作为治疗肘关节骨关节炎的过渡治疗方法。     

半开放手术松解治疗肘管综合征合并肘关节骨性关节炎35例北大核心CSCD

目的探讨半开放手术松解治疗肘管综合征合并肘关节骨性关节炎(osteoarthritis,OA)的临床疗效。方法2017年1月~2021年2月我科采取关节镜结合内侧切开松解尺神经前置的半开放手术治疗35例肘管综合征合并肘关节OA。关节镜下探查并清理关节内骨赘,切除挛缩的关节囊,切开直视下切除尺骨鹰嘴后内侧骨赘,同时进行尺神经松解前置处理。采用Mayo肘关节功能评分(Mayo Elbow Performance Score,MEPS)、疼痛视觉模拟评分(Visual Analogue Scale,VAS)及尺神经功能定量评定标准评价疗效。结果35例随访12~30个月,平均17.3月,无异位骨化、肘关节失稳等。MEPS由术前(64.6±15.3)分提高到术后6个月(89.4±10.5)分(P=0.000),术后12个月(90.4±9.3)分(P=0.000)。VAS由术前中位数3.0分降至术后6个月1.0分和12个月0分(χ^(2)=66.865,P=0.000)。肘关节活动范围由术前72.3°±17.7°提高至术后6个月113.5°±9.0°和术后12个月114.3°±10.0°(均P=0.000)。术后6个月尺神经功能优9例,良24例,可2例;术后12个月尺神经功能优20例,良15例。术后6、12个月尺神经功能评分由术前(4.6±1.5)分显著提高至(10.7±2.0)、(12.8±1.8)分(均P=0.000),术后12个月明显高于术后6个月(P=0.000)。结论半开放式手术松解治疗肘管综合征合并肘关节OA同时解决尺神经卡压和肘关节僵硬,效果满意。     

肱尺关节成形术治疗肘关节僵直的临床疗效分析

目的：观察肱尺关节成形术治疗肘关节僵直的临床疗效。方法回顾性分析2013年1月至2015年6月在我科采用肱尺关节成形术治疗肘关节僵直患者12例,其中男10例,女2例,年龄为41~62岁,平均为（52.9±6.5）岁;所有患者均存在不同程度肘关节活动受限,影像学检查均可见肘关节骨性关节炎表现,其中5例患者可见关节囊内游离体生成。所有患者均通过肘后入路在鹰嘴窝开窗,清理、松解肘关节的前后侧并解除鹰嘴及冠状突的骨赘阻挡,达到清除阻挡、减轻疼痛、增加活动度的目的。采用梅奥肘关节功能表评估患者手术前后肘关节活动度及疼痛程度。结果12例患者获得6~20个月术后随访,平均（11.8±1.0）个月。患者术前疼痛评分为3~6分,平均（5.08±1.08）分,肘关节屈伸活动范围＜90°,平均42.08°±17.64°。术后疼痛评分为1~4分,平均（2.5±1.0）分,大多数患者肘关节屈伸活动范围＞90°,平均116.25°±16.80°。手术前后疼痛评分、活动度比较,差异均有统计学意义（均P＜0.05）。结论采用肱尺关节成形术治疗肘关节僵直,对患者术后疼痛缓解及活动度改善有明显作用,尤其适用于严重肘关节僵直患者,对肘关节活动度改善效果明显。     

手术松解治疗创伤后肘关节僵硬初步疗效报告

目的 分析手术松解治疗创伤后肘关节僵硬患者的疗效,并探讨创伤后肘关节僵硬的治疗方法 .方法 本组共12例患者,其中男性9例,女性3例;左侧、右侧各6例.患者平均年龄32岁(16～47岁).原始损伤单纯骨折7例,单纯脱位1例,骨折合并脱位2例,单纯软组织损伤2例.患者伤后以石膏或颈腕吊带固定时间平均3.3周(0～8周).患者受伤至本次手术时间平均6.4个月(1～14个月).术前平均活动度为33.8°(0°～80°).本组患者术前3例前臂旋转受限.4例患者采用后侧入路,6例患者采用内、外侧联合入路,2例采用单纯内侧入路.去除影响肘关节活动的因素,部分患者行上尺桡关节松解.术中尽量达到肘屈伸0°～140°,前臂旋前80°,旋后90°.非常规行尺神经前移.术后第1天开始主动及主动辅助肘及前臂功能锻炼.口服吲哚美辛以预防异位骨化.术前Mayo肘关节功能评分平均70.4分(50～90分).结果 所有患者均获随访,术后随访14～18个月,平均15.8个月,术后平均活动度为120.8°(100°～140°),9例患者(75% )恢复了肘关节屈伸30°～130°的功能弧度.10例患者伸肘受限10°以下,4例患者可达伸肘0°.3例术前前臂旋转受限患者术后旋转功能改善.术后Mayo肘关节功能评分平均98.8分(85-100分).患者皆无异位骨化迹象.结论 术前审慎评估患者肘关节功能情况,术中细致松解,术后早期主动及主动辅助功能锻炼,可以取得良好的临床效果.     

微创截骨钢缆接骨术治疗儿童肘内翻畸形

目的 探讨应用微创截骨钢缆接骨术治疗儿童肘内翻畸形的可行性与有效性.方法 自2004年3月至2007年10月对11例儿童(10～14岁,平均12.9岁)肘内翻患者(其中2例同时存在10°内旋)进行微创肱骨髁上楔形截骨,保留对侧骨皮质与骨膜的完整,存骨折上下端钻人2枚螺丝钉,调整旋转角度,螺钉间用钢缆进行接骨固定,术后石膏固定2 周后行功能操练.结果 11例患儿骨折全部愈合,愈合时间30～45 d,平均36.3 d,无一例感染与神经损伤发生;术前肘关节内翻角度35°±5°,肘关节功能:屈曲125°±10°,伸直10°±5°.所有患者获得20～42个月(平均33.5个月)随访,术后肘关节外翻角度8°±2°.,与术前相比,差异有统计学意义(t=16.632,P<0.05);肘关节屈曲130°±8°,伸直8°±3°,与术前相比,差异均无统计学意义(P>0.05),2例术前伴有内旋患者术后内旋得到改善.结论 采用微创截骨钢缆接骨术的方法对儿童肘内翻进行治疗,具有骨膜剥离少、骨折端稳定、骨折愈合快的优势,并可以改善旋转畸形,对肘关节伸屈功能无明显影响.     

Coonrad-Morrey半限制型假体全肘关节置换的临床应用

目的 探讨Coonrad-Morrey型半限制型假体全肘关节置换术的疗效.方法 2003年12月至2008年4月采用Coonrad-Morrey半限制型假体治疗肘部疾患30例(31肘),其中新鲜肱骨髁间骨折18例,髁间骨折内固定失效或骨折不愈合9例,类风湿性肘关节炎(RA)2例(3肘),骨性关节炎(OA)1例;其中男性8例,女性22例;年龄47～78岁,平均66岁.结果 20例(21肘)获得随访,均为骨折患者,平均随访35个月(12～52个月),术前因疼痛无法判断Mayo肘关节功能评分(MEPS评分),术后MEPS评分平均为84分;21肘中,6肘优(28%),11肘良(52%),2肘可(10%),2肘差(10%).优良率80%.并发症:1例术后发生"针-针系统"失效,1例术后切口迟延愈合,1例尺神经支配区域感觉减退,2例异位骨化.结论 全肘关节置换治疗肘关节损伤可解除疼痛、恢复稳定性及改善活动范围.对于老年肱骨髁间粉碎性骨折及骨折不愈合,严格选择病例,可获得较满意疗效.     

肘关节镜"序贯五入路法"的有效性与安全性分析

目的 探讨肘关节镜"序贯五入路法"在肘关节损伤和疾病治疗中的有效性与安全性.方法 2004年4月至2007年5月期间收治53例肘关节镜手术患者,包括肘关节强直24例,骨折15例,肘关节游离体7例,桡骨小头脱位2例,关节结核8例,类风湿关节炎4例,骨化性肌炎5例,色素沉着绒毛结节性滑膜炎3例,滑膜软骨瘤1例.手术入路采用"序贯五入路法",由肘后"软点"建立第一入路后,关节镜监视下于前外侧建立第二入路,通过第二入路绕过冠突由内向外建立第三入路.再在肘后肱三头肌腱两侧建立后外侧人路和后内侧人路,作为第四、五入路.按顺序探查肘关节腔,并进行相应处理.其中3例转为切开手术.术后采取无痛性康复训练,对手术前、后肘关节Mayo功能评分进行比较.结果 46例患者术后获6～34个月(平均11.65个月)随访,Mayo评分:术前45～85分,平均(66.8±11.5)分,良14例,可21例,差11例;术后55～100分,平均(84.5～10.5)分,优16例,良21例,可8例,差1例.术后2例出现一过性神经麻痹症状,其中尺神经深支和桡神经深支各1例,3个月后恢复.结论 采用"序贯五入路法"肘关节镜下显露满意、视野清晰,手术效果好;手术入路安全,并发症少,值得在肘关节镜手术中推广使用.     

尺骨截骨矫形关节囊松解紧缩治疗儿童陈旧性孟氏骨折

目的 :探讨儿童陈旧性孟氏骨折的手术治疗经验及治疗效果。方法 :自2013年1月至2017年12月治疗32例陈旧性孟氏骨折,男18例,女14例;年龄2~9(5.3±1.2)岁;均无桡神经损伤症状。患者术前症状为肘关节疼痛、畸形,屈伸及前臂旋转受限,X线示尺骨畸形愈合或呈"弓形征",桡骨头脱位或半脱位。术中作尺骨脊后方切口,在尺骨成角畸形最明显处行额状面长斜形截骨,然后采用Boyd切口显露肱桡关节及上尺桡关节,清理关节内的瘢痕组织,复位桡骨头,并在维持肘关节稳定的前提下,对尺骨截骨处进行处理,予钢板螺钉内固定。结果:32例患儿均随访,时间12~24个月,平均14.8个月,其中1例患儿出现术口感染。根据Mackay评定标准:32例患儿术后均无肘、腕关节疼痛症状,29例患儿肘关节屈伸活动度(130±5)°/0°,前臂旋前旋后活动度90°/(85±5)°;2例患儿肘关节屈伸活动度(119°/8°,121°/7°),前臂旋前旋后活动度(90°/75°,85°/60°);1例患者肘关节屈伸活动度90°/10°,前臂旋前旋后活动度80°/60°。优29例,良2例,中1例。结论:尺骨截骨矫形、肘关节后关节囊松解、前关节囊紧缩是治疗儿童陈旧性孟氏骨折的有效方法。     

Total elbow replacement for the management of the ankylosed or fused elbow

This study reports our experience with total elbow replacement for fused elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed elbows were treated with a linked semi-constrained non-custom total elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37 degrees of extension to 118 degrees of flexion was achieved. Outcomes were good or excellent for seven elbows at final review. Ten patients felt better or much better after total elbow replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one elbow following fracture of the ulnar component. Three patients developed a deep infection. Three elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total elbow replacement for the ankylosed elbow should be performed with caution. However, the outcome can be reliable in the long term and have a markedly positive impact on patient function and satisfaction. The high potential for complications must be considered. We consider total elbow replacement to be an acceptable procedure in selected patients with reasonable expectations.     

Total elbow arthroplasty after interposition arthroplasty for elbow arthritis

BACKGROUND: Interposition arthroplasty is an option for the treatment of arthritis of the elbow. Conversion to a total elbow arthroplasty can be considered later, when the patient reaches a suitable age. We investigated the results of conversion of an interpositional elbow arthroplasty to a semiconstrained total elbow arthroplasty in a series of patients. METHODS: The results of twelve consecutive linked semiconstrained total elbow arthroplasties in twelve patients who had had a prior interposition arthroplasty for the treatment of degenerative arthritis of the elbow were evaluated at an average of ten years postoperatively. The average age at the time of the total elbow arthroplasty was fifty years, and the average interval from the interposition arthroplasty to the total elbow arthroplasty was 9.9 years. Pain and elbow performance as measured with the Mayo Elbow Performance Score were assessed in a retrospective chart review and an evaluation of questionnaires, and postoperative radiographs were reviewed. RESULTS: At the time of the latest follow-up, postoperative pain was rated as mild or none in ten of the twelve patients, and the result was rated as subjectively satisfactory in ten patients. The average Mayo Elbow Performance Score improved from 32.1 points (range, 10 to 70 points) preoperatively to 80.4 points (range, 40 to 100 points) postoperatively (p < 0.001). According to these objective criteria, there were three excellent, six good, one fair, and two poor results. All of the elbows were stable following the arthroplasty. Radiographs demonstrated a well-fixed prosthesis in all but one patient who had extensive osteolysis at the site of the humeral component. One other patient had radiographic evidence of bushing wear. Both of these patients required revision procedures. CONCLUSIONS: Semiconstrained total elbow arthroplasty can be performed successfully in patients with a prior interposition arthroplasty. Reliable pain relief and a satisfactory result can be achieved in most patients.     

Arthroscopic synovectomy of the elbow in rheumatoid arthritis

BACKGROUND: The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis. METHODS: Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groups--Grades 1 and 2, Grade 3, and Grade 4--according to the preoperative radiographic findings. These groups were then compared. RESULTS: The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows. CONCLUSIONS: Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.     

Total elbow arthroplasty. Indications,operative technique and results after implantation of an Acclaim elbow prosthesis

Total elbow arthroplasty has become a reliable treatment option for patients with rheumatoid arthritis as well as primary or posttraumatic arthrosis. The aim of this study is to present the indications, operative technique and results for the implantation of an Acclaim elbow prosthesis. Case reports are given to demonstrate the indications for prosthesis implantation. Furthermore, the follow-up results are reported for 65 patients after implantation of an Acclaim prosthesis. Pre- and postoperative pain were evaluated using the visual analogue scale. The pain level decreased from 8.0 to 2.3 postoperatively. After implantation of an elbow prosthesis, there was a significant improvement in the range of motion. The mean flexion increased from 103 degrees preoperatively to 140 degrees postoperatively. An increase of 10 degrees was found for both supination and pronation. Complications included temporary ulnary nerve irritation in seven patients, intraoperative fractures in four cases and postoperative elbow dislocation in one case. In conclusion, total elbow arthroplasty results in a reduction of pain and an improvement in elbow movement. However, selection of the right patient is important. Patients are advised not to lift heavy objects or to perform hard physical work. If patients' compliance can not be ensured preoperatively, no total elbow arthroplasty should be performed.     

全肘关节置换术治疗复杂肱骨髁间骨折的早期临床疗效分析

目的探讨肘关节置换术治疗复杂肱骨髁间骨折的早期疗效。方法2005年8月至2006年4月,通过肘关节置换术治疗3例复杂肱骨髁间骨折患者。1例男性,38岁,伴血友病关节炎,AO分型为C2型骨折,行一期肘关节置换。2例女性,年龄分别为66、82岁,伴类风湿关节炎,其中1例AO分型为C1型,行一期肘关节置换;另1例AO分型为C2型,行切开复位内固定手术失败后接受肘关节置换术。以Mayo评分评估其肘关节功能。结果3例患者均获得随访,随访时间3～10个月。1例伴血友病关节炎的肱骨髁间骨折患者术后的Mayo评分为良(75分),2例伴类风湿关节炎的肱骨髁间骨折患者中,内固定手术失败后接受肘关节置换的患者Mayo评分为良(85分),另1例患者的Mayo评分为优(95分)。3例肘关节置换患者近期随访均未出现疼痛、假体松动或假体周围骨折等并发症。结论对年龄偏大、骨质疏松明显、骨折粉碎难以复位和固定、关节毁损严重的老年肱骨髁间骨折患者,实施肘关节置换术可获得满意疗效。     

Surgical options for the arthritic elbow

Elbow arthritis is a debilitating condition manifesting as a painful, stiff elbow. Surgical treatment is based on disease etiology, severity of degeneration, and patient age. Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis. Age and functional requirements are treatment determinants for moderate to severe arthritis. Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement; posttraumatic and osteoarthritic elbows in younger patients with considerable functional demands are treated with interpositional arthroplasty. Total elbow allografts and elbow arthrodeses are considered only in salvage situations.     

Condylar nonunions of the elbow

Between 1968 and 1978, 32 patients were seen with nonunion of distal humerus fractures in close proximity to the elbow: 25 were treated with open reduction and fixation of the nonunion, and seven patients were treated with excision of the distal fragments and total elbow arthroplasty. Of the 25 patients treated with open reduction and fixation, 22 had union at an average of 7.74 months. However, six of these patients needed secondary procedures for repeat bone grafting or revision of the fixation device. Two of the seven patients with total elbow arthroplasty needed reoperation for loose humeral components.     

Rheumatoid elbow

The elbow is often involved in the progression of rheumatoid arthritis. Because of the elbow's unique role in maneuvering and positioning the hand in space, loss of normal elbow motion, loss of stability, or increased pain with the use of the elbow are all significant sources of impairment in patients with rheumatoid arthritis. The improvements in disease-modifying medications have greatly diminished the prevalence of severe elbow degeneration among patients with rheumatoid arthritis. However, it hasn't been eliminated. In this article the authors discuss strategies for managing it.     

Functional outcome of semiconstrained total elbow arthroplasty

BACKGROUND: The objective of the present study was to review the results of primary total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. Two hypotheses were tested: (1) the results in patients with inflammatory arthritis would be superior to those in patients with a traumatic or posttraumatic condition, and (2) the isometric extensor torque after total elbow arthroplasty would be significantly less than that of the contralateral elbow. METHODS: Forty-seven consecutive patients (fifty-one elbows) had the operation performed by one of three surgeons between November 1, 1989, and June 30, 1996. Thirty-six surviving patients (thirty-nine elbows) were available for follow-up. The mean duration (and standard deviation) of follow-up was 50 +/- 11 months (range, twenty-four to ninety-seven months). The mean age at the time of the operation was 64 +/- 11 years (range, twenty-seven to eighty-seven years). Eighteen patients (twenty-one elbows) had inflammatory arthritis. Eighteen patients (eighteen elbows) had an acute fracture or posttraumatic condition (posttraumatic osteoarthritis in eight, an acute fracture of the humerus in seven, nonunion of the distal aspect of the humerus in two, and primary osteoarthritis in one). The patients were evaluated with use of questionnaires (the Mayo elbow performance index, the Short Form-36 [SF-36], and the Disabilities of the Arm, Shoulder and Hand [DASH] Questionnaire); clinical examination by an orthopaedic surgeon who was not involved with the pre-operative, operative, postoperative, or follow-up care; radiographs; and elbow strength-testing with an isokinetic dynamometer. RESULTS: The mean score (and standard deviation) on the Mayo elbow performance index for the group that had inflammatory arthritis (90 +/- 11 points) was significantly higher than that for the group with a traumatic or posttraumatic condition (78 +/- 18 points) at the time of the latest follow-up (p < 0.05). In both groups, the mean extensor torque of the involved elbow was significantly less than that of the contralateral elbow (p < 0.05). No significant difference between the groups was found with respect to the flexion-extension arc of motion. Ten elbows (26 percent) had ulnar nerve dysfunction (a transient deficit in six and a permanent deficit in four); nine (23 percent), an intraoperative fracture (of the humeral diaphysis in four, of the ulnar diaphysis in four, and of the olecranon in one); three (8 percent), a periprosthetic infection; three, a triceps disruption; and one (3 percent), a revision because of a fracture of the ulnar component. There were no other revisions. Of the thirty-four elbows with complete radiographic follow-up, twenty-three had no change in the bone-cement interface. Progressive radiolucency was noted around the ulnar prosthesis in eight elbows, around the humeral prosthesis in one elbow, and around both components in two elbows. CONCLUSIONS: Patients who had a total elbow arthroplasty with use of a semiconstrained Coonrad-Morrey prosthesis were generally satisfied; the mean level of patient satisfaction was 9.2 of a possible 10 points for those who had inflammatory arthritis and 8.6 points for those who had a fracture or posttraumatic condition. The rates of complications involving the ulnar nerve, intraoperative fracture, triceps disruption, deep infection, and periprosthetic radiolucency are of concern.     

Interposition elbow arthroplasty

Pain and loss of motion associated with elbow arthritis is poorly tolerated and constitutes a major functional impairment. While total elbow arthroplasty reliably alleviates pain and improves motion, durability issues mandate restricted indications and light use. Interposition arthroplasty, combined with hinged external fixation, is an alternative and may be preferred in younger, more active patients anticipating heavier use.