Surgical release for tubercular elbow stiffness

Abstract

Yun Qian,1,2,* Qixin Han,3,* Wei Wang,1,2,* Yuanming Ouyang,1,2 Weien Yuan,4 Cunyi Fan1 1Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 2Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, 3Renji Hospital, School of Medicine, 4School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China *These authors contributed equally to this work Background: For 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 methods: We 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.Results: At 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.Conclusion: Open arthrolysis and hinged external fixation are useful for the treatment of non-traumatic elbow stiffness with TB. Keywords: open arthrolysis, hinged external fixation, non-traumatic, heterotopic ossification

Keywords

• Tuberculosis
• elbow stiffness
• open arthrolysis
• hinged external fixation;