Elbow interposition arthroplasty in children and adolescents: long-term follow-up

A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years' follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland's technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90 degrees and 120 degrees of flexion and 30 degrees and 90 degrees of extension. Post-operative range varied between 90 degrees and 150 degrees of flexion. The five cases of full pre-operative ankylosis achieved between 90 degrees and 150 degrees of flexion and between 0 degrees and 70 degrees of extension. The total range of motion at the latest follow-up varied from 35 degrees to 150 degrees. Patients who were able to perform flexion of 120 degrees or more were considered to be excellent, those between 90 degrees and 119 degrees were graded good, from 60 degrees to 89 degrees fair and those 59 degrees or less poor. The ability to attain a hand to mouth position requires a mobility of 120 degrees. We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed.