Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft

• Published in: Shoulder & elbow Vol. 8; no. 1; pp. 48 - 53
• Main Authors: Jen, Chi Loong, Tan, James Chung Hui
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2016
• Subjects: Elbow; elbow arthrodesis; fusion; bone graft; neuropathic arthropathy; Charcot joint
• ISSN: 1758-5732; 1758-5740
• DOI: 10.1177/1758573215598731

Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient’s suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion