Nonimplantation Salvage of Severe Elbow Dysfunction

Published on 11/04/2015 by admin

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CHAPTER 67 Nonimplantation Salvage of Severe Elbow Dysfunction

INTRODUCTION

Today, several salvage options exist for severe elbow dysfunction following trauma or failed prior intervention. If the joint is stiff and destroyed, interposition arthroplasty is recommended (see Chapter 69). If strength is required in a young person, especially if the joint is infected, fusion may be considered (see Chapter 70). If the injury is to the brachial plexus, strategies for management are discussed in Chapter 71. In this chapter, we review resection arthroplasty and allograft reconstruction for massive bone loss.

RESECTION ARTHROPLASTY

Removal of articular bone, as a reconstructive strategy, is not an acceptable procedure. Badly com-minuted articular fracture fragments may be excised in the setting of extensive soft tissue damage or contamination. In the absence of sepsis, these problems are subsequently addressed by prosthetic or allograft reconstruction.

SEGMENTAL BONE LOSS

The unstable or “flail” elbow with segmental bone loss, that is, complete loss of articulation and ligament attachments, is difficult to manage. Treatment with a primary replacement is discussed in Chapters 59 and 66. This problem can be a sequel of trauma, infection, failed elbow arthroplasty, or tumor resection. Bone may be lost at the original injury following a severe open fracture, or it may be removed subsequent to infection, particularly if the fragment is avascular. In treating recalcitrant union of supracondylar fractures, surgeons have in the past (and disastrously) succumbed to the temptation to remove the condylar fragment of the humerus and treat the problem by inserting an endoprosthesis.

If the problem is limited to just the articular region of the humerus, a hemireplacement may be effective (Fig. 67-7). If, however, all stability and distal contour of the humerus is lost, today, a linked replacement is performed for such patients (see Chapter 59).

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