• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Elbow Arthrodesis- Indications, Methods and Complications

By Dr Arun Pal Singh

In this article
    • Indications of Elbow Arthrodesis
    • Contraindications
    • Position for Elbow Arthrodesis
    • Surgical Procedure
    • Complications
    • Conclusion
    • References
      • Related

Last Updated on August 12, 2023

Elbow arthrodesis refers to the surgical fusion of the elbow joint. It is not a commonly performed procedure in modern times.

Historically, infection, mainly tuberculosis leading to a painful ankylosed elbow has been the main indication for performing elbow arthrodesis. But with modern chemotherapy, socioeconomic development has led to the reduction of tuberculosis drastically.

Nowadays, surgical fusion of the elbow is a salvage procedure only.

The procedure aims to fuse the elbow to produce a painless and stable elbow in a functional position. The position of the elbow varies depending on the demands/profession of the patient and other factors like the condition of the other elbow, shoulder, and spine.
The outcomes of the procedure are variable and complications may occur.

Indications of Elbow Arthrodesis

Elbow arthrodesis is often a last resort procedure in modern times because the loss of motion significantly affects the quality of life of the patient.

Total elbow arthroplasty is a more commonly done procedure as it provides a mobile elbow. So in a nutshell, elbow arthrodesis is considered only in cases of failed arthroplasties and in patients where arthroplasties are contraindicated.

Elbow arthrodesis can be considered in the following situations

  • Intractable painful and unstable elbow
  • Elbow joint destruction due to infection or trauma where arthroplasty is not suitable/contraindicated
    • Trauma resulting in severe comminution
      • Gunshot injury
      • Motor vehicle accidents
      • Industrial accidents
      • Large bone and soft tissue defects
    • Infection
      • Tuberculosis
      • Bacterial Infection
  • Severe rheumatoid arthritis
  • Poor bone quality
  • Young laborers with debilitating arthritis who require a strong and stable joint as arthroplasty fails under repetitive loading

Contraindications

Dysfunction or disease of the shoulder and/or upper spine is the contraindication of this procedure.

After arthrodesis of the elbow compensatory movements are provided by the upper thoracic spine and shoulder joint including the scapulothoracic joint. If there is a dysfunction of these joints, compensatory motion is not provided.

Position for Elbow Arthrodesis

The elbow is fixed in varying degrees of flexion depending on many factors including the needs and demands of the patient.

There is no angle of fusion that is suitable for all activities. Hence, it requires diligent work on both physician’s and patient’s part to reach the profile that best matches the expectation.

  • In the case of unilateral fusion, the most recommended position is 90 degrees of flexion. The elbow is fixed in neutral rotation.
  • In bilateral fusion, the angle of the fusion is 110-120 degrees in the dominant and less than 90 [45-60] degrees in the non-dominant. This allows the hands to reach the whole body for personal hygiene and a daily range of work.

The following factors must also be considered for achieving a conclusion-

  • Patient’s age
  • Occupation
  • The dominant or nondominant hand
  • Needs and requirements of the patient
  • Rotation
    • Slight pronation provides a better ability to write and use computer
    • Slight supination is better for object-holding

The choice of fusion angle must be individualized to meet each patient’s specific needs. It is highly recommended to simulate fusion via functional bracing at different angles prior to the procedure.

Elbow arthrodesis using internal fixation
Elbow arthrodesis using internal fixation
Image Credit: SAGE

Surgical Procedure

Preparation for Surgery

The wounds should heal before the procedure is taken up or planned. Extensive infection/discharge needs to be controlled by debridement, dressing, and antibiotics.

The patient should spend a lot of time in preoperative simulation by immobilizing the elbow using a functional brace. This will let the patient and physician know if the patient is ready for elbow arthrodesis or not. Also, it helps to determine the suitable position of the elbow it needs to be fused in.

Surgical Procedure Outline

  • Exposure
    • Most surgeons use a posterior approach
    • Tissues like ligaments, joint capsules, and synovium are removed and bone surfaces are exposed
    • Debridement of the remaining articular surface and sclerotic bone till the healthy bleeding bone is reached
    • The ulnar nerve should always be identified and protected because it is vulnerable during the majority of these cases as the posterior approach to the elbow is used. Depending on the amount of bone resected and the position of hardware placement, ulnar nerve transposition may be required.
  • Fixation
    • Internal fixation is usually preferred as it provides rigid compression across the arthrodesis site
    • Implants
      • Posterior plating is the preferred method
      • Compression screws
      • External fixators
      • Various combinations of the above
  • Bone grafting
    • Fills the gap. if any between compressed surfaces
    • Hastens union and reduces the risk of nounion

Complications

  • Infection
  • Persistent nerve pain (neuroma)
  • Failure of implant like loosening or breakage
  • Breakdown of skin or scar
  • Refracture

Conclusion

The goal of elbow arthrodesis is to produce a painless, immobile elbow. Therefore,, the procedure needs to be justified and used as a last resort only. The patient should definitely undergo preoperative simulation as to how would arthrodesis affect the quality of life and what is the best position for fusion in his case.

When carefully and diligently selected, the procedure yielded good results and allowed the patients to go back to work.

A successful procedure is one that leads to patient satisfaction and keeps her pain-free.

References

  • Reichel LM, Wiater BP, Friedrich J, Hanel DP. Arthrodesis of the elbow. Hand Clin. 2011 May;27(2):179-86, vi. doi: 10.1016/j.hcl.2011.02.002.
  • Koller H, Kolb K, Assuncao A, Kolb W, Holz U. The fate of elbow arthrodesis: indications, techniques, and outcome in fourteen patients. J Shoulder Elbow Surg. 2008; 17(2):293–306.
  • Kwon YW, Morrey BF. Neuropathic elbow arthropathy: a review of six cases. J Shoulder Elbow Surg 2006;15:378-82
  • Kovack TJ, Jacob PB, Mighell MA. Elbow arthrodesis: a novel technique and review of the literature. Orthopedics. 2014; 37(5):313–319. 10.3928/01477447-20140430-04

Related

Spread the Knowledge
1
Share
 
1
Share
1    

Filed Under: Hand and Upper Limb, Procedures

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

Ilioinguinal approach Incision

Surgical Approaches to Acetabulum

Approaches to Acetabulum Approaches to acetabulum could be anterior approaches, posterior approaches or extensile approaches. Anterior approaches to acetabulum include Iliofemoral Approach Ilioinguinal Approach Posterior approaches to acetabulum include Kocher Langenbach Transtroachanteric Extensile approaches to acetabulum include Triradiate Transtrochanteric Extended Iliofemoral Iliofemoral Apporach to Acetabulum This approach provides access to the iliac crest and the […]

Layer by layer dissection of tissues of forearm

Dynamic Compression Plate Fixation Procedure for Forearm

A patient with fracture proximal radius and ulna was treated by dynamic compression Plate fixation. Fractures of forearm bones [radius or ulna or both] require open reduction and internal fixation in most of the adult cases. While ulna is subcutaneous bone which you can palpate from elbow to wrist,the radius is deep situated. The radius can […]

Lower Back Pain image

Lower Back Pain – Causes and Treatment

Lower back pain can result from muscles and tendons of the back, nerve roots, joints of spine and viscera. Few of these lower back pain are acute whereas others are chronic in nature. The symptoms and severity of lower back pain vary greatly. What is seemingly a simple symptom may in fact point to a […]

Changes in dislocated hip

Developmental Dysplasia of Hip or Congenital Dislocation of Hip

Developmental dysplasia of hip refers to patients being born with dislocation or instability of the hip, which may then result in hip dysplasia. It means that there is an instability of the hip which results in changes in anatomical structures as the child grows. The structures that undergo dysplastic changes are the acetabulum and the […]

Types of lesion in tuberculosis of spine

What is Spinal Tumor Syndrome?

Spinal tumor syndrome is not a condition in itself. It is a clinical label for the patient’s condition with many differentials in the offering. Most often, the term is used in cases of spine tuberculosis where there is no apparent osseous lesion. To understand spinal tumor syndrome one must first know about the typical presentation […]

Fluoroscopic Image of Nuceloplasty

What Is Nucleoplasty?

Nucleoplasty is a percutaneus procedure where a catheter is percutaneously inserted into the intervertebral disc under fluoroscopy. The catheter has low-temperature resister probe to disintegrate and evacuate disc material causing disc decompression. The nucleoplasty is percutaneous and does not require any incision. Indications for Nucleoplasty It is most useful in patients with nerve root irritation […]

Hawkins Classification of Talar Neck Fractures

Talar Neck Fractures Causes and Management

Talar neck fractures are a most common fracture of talus and account for about 50% of the talar fractures. Talar neck fractures are high high-energy injuries which are usually caused by forced dorsiflexion with the axial load. Ipsilateral lower extremity fractures common with these fractures. Anatomy of Talus Read about anatomy of talus. Talus consists […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage {vendor_count} vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...