Inverted ‘V’ osteotomy excision arthroplasty for bony ankylosed elbows

Background

Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted ‘V’ osteotomy excision arthroplasty in our hospital with good functional results.

Materials

Our case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation.

Results

The average duration of follow up is 65 months (45 months-80 months). The mean Mayo’s elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-50⁰), 116°of flexion (110⁰-130⁰), and the arc of motion was 88°(80⁰-100⁰). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities.

Conclusion

We conclude that inverted ‘V’ osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.