Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra diffi...Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. Methods： We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients＇ data were collected to evaluate the clinical outcome. Results： All patients had a Grade Ill ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. Conclusions： Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.展开更多
Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described.We reported a 39 years old polytrauma patient with complex open elbow fracture(Gustilo-Anderson type IIIB).The patien...Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described.We reported a 39 years old polytrauma patient with complex open elbow fracture(Gustilo-Anderson type IIIB).The patient presented with large soft tissues defect on dorsal part of the left elbow,ulnar palsy due to the irreparable loss of the ulnar nerve,distal triceps loss due to the complete loss of the olecranon,loss of both humeral condyles with collateral ligaments and complex elbow instability.Only few similar cases have been published.Reconstructive surgery included repetitive radical debridement,irrigation,vacuum assisted closure system therapy,external fixation,coverage of the soft tissue defect with fascia ecutaneous flap from the forearm.Four months after the injury,total elbow arthroplasty with autologous bone graft(from the proximal radius)inserted in the ulnar component,was performed.At 3 years postoperatively,the patient is able to perform an active flexion from 0to 110with full pronosupination.Only passive extension is allowed.The ulnar neuropathy is persistent.Patient has no signs of infection or loosening of the prosthesis.展开更多
文摘Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. Methods： We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients＇ data were collected to evaluate the clinical outcome. Results： All patients had a Grade Ill ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. Conclusions： Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.
文摘Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described.We reported a 39 years old polytrauma patient with complex open elbow fracture(Gustilo-Anderson type IIIB).The patient presented with large soft tissues defect on dorsal part of the left elbow,ulnar palsy due to the irreparable loss of the ulnar nerve,distal triceps loss due to the complete loss of the olecranon,loss of both humeral condyles with collateral ligaments and complex elbow instability.Only few similar cases have been published.Reconstructive surgery included repetitive radical debridement,irrigation,vacuum assisted closure system therapy,external fixation,coverage of the soft tissue defect with fascia ecutaneous flap from the forearm.Four months after the injury,total elbow arthroplasty with autologous bone graft(from the proximal radius)inserted in the ulnar component,was performed.At 3 years postoperatively,the patient is able to perform an active flexion from 0to 110with full pronosupination.Only passive extension is allowed.The ulnar neuropathy is persistent.Patient has no signs of infection or loosening of the prosthesis.
