RESUMO
Elbow arthrodesis is a salvage operation designed to relieve pain and enable weight bearing in young patients with painful arthritic joints who have failed all other treatment modalities. Unfortunately, elbow arthrodesis is poorly tolerated by many patients because there is no fusion position that accommodates all activities of daily living. As indications for elbow arthroplasty expand and implant design improves, patients living with elbow arthrodesis may seek conversion to arthroplasty to regain a functional range of motion. Only one case of elbow arthrodesis to elbow arthroplasty conversion has been reported in the English literature to date. We present the case of a 58 year old male, five years status post elbow arthrodesis, unable to perform his ADLs adequately, who was successfully converted to a total elbow arthroplasty. Indications, contraindications, and technical pearls are discussed.
RESUMO
Glenohumeral arthrodesis is a salvage procedure indicated for brachial plexus palsy, refractory instability, humeral and/or glenoid bone loss, deltoid and rotator cuff insufficiency, and chronic infections. The aim is to provide a painless, stable shoulder that is positioned to maximize function. Scapulothoracic motion as well as motion of the elbow and hand deliver satisfactory function in most patients. Intra-articular, extra-articular, and more commonly, combined techniques involving glenohumeral and humeroacromial fusion, have been described. More recently, authors have reported arthroscopic assisted techniques for shoulder arthrodesis with promising results as well as less complicated conversion from shoulder arthrodesis to reverse total shoulder arthroplasty. Despite advances in materials and techniques, glenohumeral arthrodesis continues to be associated with complication rates as high as 43%. A thorough understanding of the indications, contraindications, outcomes, and complications is paramount to improving patient results. Glenohumeral arthrodesis is a safe and effective procedure for the appropriate indications. The high frequency of complications mandates a frank preoperative discussion to ensure that each patient understands the magnitude of the procedure, its risks, possible complications, and expected outcome.
RESUMO
Nonoperative treatment of ulna-shaft fractures may result in healing with residual displacement. In the study reported here, we used a cadaveric model to try to determine whether displacement significantly reduces forearm supination and pronation. Transverse osteotomies were made one third, one half, and two thirds of the distance from the proximal end to the distal end of each of 7 fresh cadaveric forearms. Displacements of 50% and 100% were tested at each osteotomy site. Specimens were mounted on a material-testing machine, and forearm rotation was determined. Supination loss was less than 15 degrees for all directions of displacement at all osteotomy sites. Pronation loss was less than 10 degrees at the distal osteotomy site; at the middle osteotomy site, pronation loss was 19 degrees with 100% radial displacement (P < .05) and 20 degrees with 100% ulnar displacement (P< .05); and, at the proximal osteotomy site, pronation loss was 19 degrees with 50% radial displacement (P < .01), 41 degrees with 100% radial displacement (P < .0005), and 33 degrees with 100% ulnar displacement (P < .005). We conclude that large residual displacement in distal fractures and moderate residual displacement in midshaft fractures do not significantly compromise forearm rotation. Proximal displacement was less tolerated in this model and resulted in significantly reduced forearm rotation.
