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Ellenbogengelenkarthrodese

Indikation, Operationsverfahren und klinische Ergebnisse

Arthrodesis of the elbow joint

Indications, surgical technique and clinical results

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Zusammenfassung

Die Indikation zur Ellenbogengelenkarthrodese (EA) ist selten. Sie gilt als „Rettungsoperation“, führt allerdings zu einer empfindlichen Funktionsbeeinträchtigung der oberen Extremität. Im Zeitraum 1/1997 bis 12/2005 wurde bei 20 Patienten eine EA durchgeführt. Das Durchschnittsalter lag bei 55 (27–85) Jahren. Die EA erfolgte in 18 Fällen mit einer Kompressionsplatte, in 18/20 Fällen wurde die Indikation posttraumatisch nach Infektionen, Gewebedefekten und schmerzhafter Ellenbogensteife gestellt. Alle EA waren knöchern konsolidiert und stabil; der Arthrodesenwinkel betrug im Schnitt 89° (80–110°). Die grobe Kraft war im Seitenvergleich um 27% reduziert. Im Morrey-Score erreichten die Patienten 56 Punkte, im DASH-Score (DASH „disabilities of the arm, shoulder and hand“) 38,29 und im Constant-Murley-Score 80 Punkte. Die Indikation ist multifaktoriell. Dabei müssen die alltäglichen Bedürfnisse und Präferenzen des Patienten berücksichtigt werden. Der bestmögliche Arthrodesenwinkel ist präoperativ zu validieren. In diesem Fall kann eine EA dem Patienten eine gute Kraftentfaltung und eine hohe Stabilität bei einer definierten Funktionseinschränkung der oberen Extremität gewährleisten.

Abstract

Arthrodesis of the elbow joint (EA) is a rare salvage procedure which is disliked by both surgeons and patients. The aim of this study was to analyze the indications, the operation techniques and the outcome of EA in patients treated at our clinic. Between January 1997 and December 2005 a total of 20 patients with a mean age of 55 years (range 27-85 years) were treated with EA at our clinic. In 18 patients a compression plate was used as surgical technique. In 18 out of the 20 patients the operation was performed post-traumatically after infection, bone and tissue defects and painful loss of motion. Of these patients, 16 could be followed up for an average time of 66 months. The outcome was evaluated based on the degree of pain, range of motion, radiographic findings and grip strength measured with the Jamar dynamometer. All patients had a solid and fused EA, the average angle was 89° (range 80-110°) and the grip strength was reduced by 27% compared to the unaffected side. The patients achieved 56 points in the Morrey score, 38.29 points in the DASH (disabilities of the arm, shoulder and hand) score and 80 points in the Constant-Murley score. The indication of EA depends on several factors, therefore it is essential to take the patients’ functional requirements into consideration and the best arthrodesis angle should be validated pre-operatively. In these cases the patients can regain good grip strength and a high level of stability within defined functional limitations.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    A. Moghaddam-Alvandi, E. Dremel, F. Güven, V. Heppert, C. Wagner, S. Studier-Fischer, P.A. Grützner & B. Biglari

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  1. A. Moghaddam-Alvandi
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  2. E. Dremel
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  3. F. Güven
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  4. V. Heppert
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  5. C. Wagner
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  6. S. Studier-Fischer
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  7. P.A. Grützner
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  8. B. Biglari
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Correspondence to A. Moghaddam-Alvandi.

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Ein positives Votum der Ethikkommission der Landesärztekammer Mainz zur Durchführung dieser Studie liegt vor.

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Moghaddam-Alvandi, A., Dremel, E., Güven, F. et al. Ellenbogengelenkarthrodese. Unfallchirurg 113, 300–307 (2010). https://doi.org/10.1007/s00113-009-1722-y

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  • DOI: https://doi.org/10.1007/s00113-009-1722-y

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