Reconstructive surgeries and endoprosthetics of the elbow joint: indications, possibilities and prospects

Abstract

BACKGROUND: Severe injuries of the elbow joint and their consequences are a serious problem in modern traumatology and orthopedics due to the large number of unsatisfactory treatment results, in particular, due to the lack of a differentiated approach to the choice of tactics and the method of surgery.

AIM: To evaluate the results of a differentiated approach to the choice of tactics and the method of surgical intervention in the treatment of patients with injuries and consequences of injuries of the elbow joint.

MATERIALS AND METHODS: The results of treatment of 245 patients with injuries and consequences of damage to the elbow joint were assessed within 11 years from the date of surgery. Six groups of patients were identified: group 1 — osteosynthesis of fractures of the elbow joint; 2nd — open arthrolysis without the imposition of Oganesyan’s hinged distraction apparatus (HDA); 3rd — open arthrolysis with the imposition of HDA; 4th — arthroscopic arthrolysis without HDA imposition; 5th — arthroscopic arthrolysis with the imposition of HDA; 6th — elbow arthroplasty.

RESULTS: In 93% of patients after osteosynthesis (1st group of patients), a good result was obtained (the deficit in the range of motion was not more than 10°, the average score on the DASH scale was 8). In patients after arthrolysis, there is a twofold increase in the range of motion (on average from 42°–50° to 114°–120°), and regardless of the method of arthrolysis (arthroscopic or open) and whether HDA was used or not. On the DASH scale, 89% of patients showed a decrease in points on average from 77 to 36. In the 6th group, an increase in the range of motion was noted on average from 45°–48° to 126°–135°, on the DASH scale — a decrease in points from 79–82 to 39–44 on average. Revision intervention was required in 28.4%.

CONCLUSION: The choice of the method of surgical treatment of injuries and the consequences of severe injuries of the elbow joint directly depends on the degree and nature of destruction of the bone-articular and soft tissue structures, the deficit in the range of motion in the joint.

Keywords

elbow / elbow joint / elbow arthrolysis / endoprosthesis elbow joint

References

[1] Soldatov YP, Makushin VD. The results of reconstructive surgeries for the elbow ankyloses. Genii ortopedii. 2003;(1):40–43. (In Russ).

[2] Солдатов Ю.П., Макушин В.Д. Результаты реконструктивных операции при анкилозах локтевого сустава // Гений ортопедии. 2003. № 1. С. 40–43.

[3] Zhabin GI. Travmy loktevogo sustava. In: Kornilov NV, editor. Traumatologiya i ortopediya: rukovodstvo dlya vrachei. St. Petersburg: Gippokrat; 2005. P. 167–218. (In Russ).

[4] Жабин Г.И. Травмы локтевого сустава. В кн.: Травматология и ортопедия: руководство для врачей / под ред. Н.В. Корнилова. Санкт-Петербург: Гиппократ, 2005. С. 167–218.

[5] Kliuchevsky VV, Hassan Ben El Hafi. The elbow contracture prevention in treatment of humeral distal segment fractures. Genii ortopedii. 2010;(2):74–98. (In Russ).

[6] Ключевский В.В., Хассан Б.Э.Х. Профилактика контрактур локтевого сустава при лечении переломов дистального сегмента плечевой кости // Гений ортопедии. 2010. № 2. С. 74–98.

[7] Mironov SP, Oganesyan OV, Seleznev NV, Khapilin AP. Restoration of elbow function in old forearm dislocation by combined using of arthroscopic technique and hinge-distraction device. N.N. Priorov Journal of Traumatology and Orthopedics. 2006;(1):33–38. (In Russ).

[8] Миронов С.П., Оганесян О.В., Селезнев Н.В., Хапилин А.П. Восстановление функции локтевого сустава при застарелых вывихах костей предплечья путем комбинированного применения артроскопической техники и шарнирно-дистракционного аппарата // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2006. № 1. С. 33–38.

[9] Parker P, Furness ND, Evans JP, et al. A systematic review of the complications of contemporary total elbow arthroplasty. Shoulder Elbow. 2021;13(5):544–551. doi: 10.1177/1758573220905629

[10] Parker P., Furness N.D., Evans J.P., et al. A systematic review of the complications of contemporary total elbow arthroplasty // Shoulder Elbow. 2021. Vol. 13, N 5. P. 544–551. doi: 10.1177/1758573220905629

[11] Slobodskoi AB, Prokhorenko VM, Dunaev AG, et al. The elbow arthroplasty in young patients. Genii ortopedii. 2015;(2):26–31. (In Russ). doi: 10.18019/1028-4427-2015-2-26-31

[12] Слободской А.Б., Прохоренко В.М., Дунаев А.Г., и др. Эндопротезирование локтевого сустава у молодых пациентов // Гений ортопедии. 2015. № 2. С. 26–31. doi: 10.18019/1028-4427-2015-2-26-31

[13] Samdanis V, Manoharan G, Jordan RW, et al. Indications and outcome in total elbow arthroplasty: a systematic review. Shoulder Elbow. 2020;12(5):353–361. doi: 10.1177/1758573219873001

[14] Samdanis V., Manoharan G., Jordan R.W., et al. Indications and outcome in total elbow arthroplasty: a systematic review // Shoulder Elbow. 2020. Vol. 12, N 5. P. 353–361. doi: 10.1177/1758573219873001

[15] Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. Philadelphia: Saunders; 1985. P. 73–91.

[16] Morrey B.F., An K.N., Chao E.Y.S. Functional evaluation of the elbow. In: Morrey B.F., editor. The elbow and its disorders. Philadelphia: Saunders, 1985. P. 73–91.

[17] Aliev AG, Ambrosenkov AV, Boyarov AA, et al. Midand long-term results of total elbow arthroplasty: post-traumatic consequences and rheumatoid arthritis. Travmatologiya i ortopediya Rossii. 2019;25(1):41–51. (In Russ). doi: 10.21823/2311-2905-2019-25-1-41-51

[18] Алиев А.Г., Амбросенков А.В., Бояров А.А., и др. Сравнительная эффективность тотального эндопротезирования локтевого сустава у пациентов с последствиями травм и ревматоидным артритом в среднесрочном и отдаленном периодах // Травматология и ортопедия России. 2019. T. 25, № 1. С. 41–51. doi: 10.21823/2311-2905-2019-25-1-41-51

[19] Kesyan GA, Arsenyev IG, Urazgildeev RZ, Karapetyan GS. Differentiated approach to surgical treatment of the consequences of severe injury of the elbow joint. Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2017;16(4):161–167. (In Russ).

[20] Кесян Г.А., Арсеньев И.Г., Уразгильдеев Р.З., Карапетян Г.С. Дифференцированный подход к оперативному лечению последствий тяжёлых поврежденией локтевого сустава // Вестник Смоленской государственной медицинской академии. 2017. Т. 16, № 4. С. 161–167.

[21] Shuiskiy AA, Kesyan GA, Urazgil’deev RZ, et al. Experience in treatment of distal humeral epimetaphyseal intra-articular fractures using combined osteosynthesis by submersible screws and external fixation hinge distraction system. N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):56–62. (In Russ). doi: 10.32414/0869-8678-2018-2-56-62

[22] Шуйский А.А., Кесян Г.А., Уразгильдеев Р.З., и др. Опыт лечения внутрисуставных переломов дистального метаэпифиза плечевой кости методом комбинированного остеосинтеза погружными винтами и шарнирно-дистракционным аппаратом внешней фиксации // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2018. T. 25, № 2. С. 56–62. doi: 10.32414/0869-8678-2018-2-56-62

[23] Kesyan GA, Urazgildeev RZ, Karapetyan GS, et al. Evolution of treatment methods of treatment of intraarticular fractures of the distal metaepiphysis of the humerus (literature review). Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2020;19(3):185–200. (In Russ). doi: 10.37903/vsgma.2020.3.27

[24] Кесян Г.А., Уразгильдеев Р.З., Карапетян Г.С., и др. Эволюция методов лечения внутрисуставных переломов дистального метаэпифиза плечевой кости (обзор литературы) // Вестник Смоленской государственной медицинской академии. 2020. Т. 19, № 3. С. 185–200. doi: 10.37903/vsgma.2020.3.27

[25] Kesyan GA, Urazgildeev RZ, Dan IM, et al. Heterotopic ossification of large joints, as a complication of injuries and diseases of the central nervous system (review). Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2017;16(4):154–160. (In Russ).

[26] Кесян Г.А., Уразгильдеев Р.З., Дан И.М., и др. Гетеротопическая оссификация крупных суставов, как осложнение травм и заболеваний нервной системы (обзор литературы) // Вестник Смоленской государственной медицинской академии. 2017. Т. 16, № 4. С. 154–160.

[27] Burkhart KJ, Hollinger B. Post-traumatic arthritis in the young patient: treatment options before the endoprosthesis. Orthopade. 2016;45(10):832–843. (In German). doi: 10.1007/s00132-016-3326-x

[28] Burkhart K.J., Hollinger B. Post-traumatic arthritis in the young patient: treatment options before the endoprosthesis // Orthopade. 2016. Vol. 45, N 10. P. 832–843. (In German). doi: 10.1007/s00132-016-3326-x

[29] Cai J, Wang W, Yan H, et al. Complications of open elbow arthrolysis in post-traumatic elbow stiffness: a systematic review. PLoS One. 2015;10(9):e0138547. doi: 10.1371/journal.pone.0138547

[30] Cai J., Wang W., Yan H., et al. Complications of open elbow arthro-lysis in post-traumatic elbow stiffness: a systematic review // PLoS One. 2015. Vol. 10, N 9. P. e0138547. doi: 10.1371/journal.pone.0138547

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