Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft
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 h...
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Published in | Shoulder & elbow Vol. 8; no. 1; pp. 48 - 53 |
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Main Authors | , |
Format | Journal Article |
Language | English |
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London, England
SAGE Publications
01.01.2016
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Abstract | 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 |
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AbstractList | 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 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. |
Author | Jen, Chi Loong Tan, James Chung Hui |
AuthorAffiliation | Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27583001$$D View this record in MEDLINE/PubMed |
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References | Galley, Bain, Stanley, Lim 2007; 8 Kovack, Jacob, Mighell 2014; 37 Kelly 1963; 37 Koehler 1991; 75 Bhaskaran, Suresh, Iyer 1981; 27 Tang, Roidis, Itamura, Vaishnau, Shean, Stevanovic 2001; 26 Yeap, Wallace 2003; 12 Stanley, Collier 2008; 22 Yanik, Tuncer, Seckin 2004; 24 Vaishya, Singh 2009; 18 Nacir, Arslan Cebeci, Cetinkaya, Karagoz, Erdem 2010; 30 Arafiles 1981; 63 Reichel, Wiater, Friedrich, Hanel 2011; 27 Ruette, Stuyck, Debeer 2007; 73 Kwon, Morrey 2006; 15 Preiss, Wigderowitz 2011; 21 Farzan, Eraghi, Mardookhpour, Yousefzadeh-Fard 2012; 41 Sharma, Coppa, Sandu 2006; 18 Fornalski, Gupta, Lee 2003; 7 Deng, Wu, Yang, Xu 2013; 18 Koller, Kolb, Assuncao, Kolb, Holz 2008; 17 Minami, Kato, Hirayama 1997; 11 Deirmengian, Lee, Jupiter 2001; 83A Nagy, Szabo, Sharkey 1999; 8 Unnanuntana, Waikakul 2006; 89 bibr4-1758573215598731 bibr21-1758573215598731 Unnanuntana A (bibr2-1758573215598731) 2006; 89 bibr18-1758573215598731 bibr25-1758573215598731 Farzan M (bibr6-1758573215598731) 2012; 41 bibr3-1758573215598731 bibr9-1758573215598731 bibr5-1758573215598731 bibr12-1758573215598731 Bhaskaran R (bibr8-1758573215598731) 1981; 27 bibr16-1758573215598731 Kelly M (bibr1-1758573215598731) 1963; 37 bibr19-1758573215598731 bibr20-1758573215598731 bibr24-1758573215598731 Ruette P (bibr7-1758573215598731) 2007; 73 bibr11-1758573215598731 bibr10-1758573215598731 bibr15-1758573215598731 bibr23-1758573215598731 bibr14-1758573215598731 Eichenholtz SN (bibr13-1758573215598731) 1966 bibr22-1758573215598731 bibr17-1758573215598731 Nagy SM (bibr26-1758573215598731) 1999; 8 |
References_xml | – volume: 21 start-page: 189 year: 2011 end-page: 192 article-title: Vascularized fibular graft arthrodesis as salvage for severe bone loss following failed revision total elbow replacement publication-title: Eur J Orthop Surg Traumatol contributor: fullname: Wigderowitz – volume: 15 start-page: 378 year: 2006 end-page: 82 article-title: Neuropathic elbow arthropathy: a review of six cases publication-title: J Shoulder Elbow Surg contributor: fullname: Morrey – volume: 27 start-page: 179 year: 2011 end-page: 86 article-title: Arthrodesis of the elbow publication-title: Hand Clin contributor: fullname: Hanel – volume: 73 start-page: 525 year: 2007 end-page: 9 article-title: Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: a report of 3 cases publication-title: Acta Orthop Belg contributor: fullname: Debeer – volume: 11 start-page: 454 year: 1997 end-page: 7 article-title: Occurrence of neuropathic osteoarthropathy of the elbow joint after fixation of the radius nonunion in a patient with syringomyelia publication-title: J Orthop Trauma contributor: fullname: Hirayama – volume: 24 start-page: 238 year: 2004 end-page: 41 article-title: Neuropathic arthropathy caused by Arnold–Chiari malformation with syringomyelia publication-title: Rheumatol Int contributor: fullname: Seckin – volume: 41 start-page: E39 year: 2012 end-page: 42 article-title: Neuropathic arthropathy of the elbow: two case reports publication-title: Am J Orthop (Belle Mead NJ) contributor: fullname: Yousefzadeh-Fard – volume: 30 start-page: 979 year: 2010 end-page: 83 article-title: Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation publication-title: Rheumatol Int contributor: fullname: Erdem – volume: 18 start-page: 303 year: 2013 end-page: 9 article-title: Neuropathic arthropathy caused by syringomyelia publication-title: J Neurosurg Spine contributor: fullname: Xu – volume: 37 start-page: 313 year: 2014 end-page: 9 article-title: Elbow arthrodesis: a novel technique and review of the literature publication-title: Orthopedics contributor: fullname: Mighell – volume: 27 start-page: 194 year: 1981 end-page: 6 article-title: Charcot's elbow (a case report) publication-title: J Postgrad Med contributor: fullname: Iyer – volume: 83A start-page: 839 year: 2001 end-page: 44 article-title: Neuropathic arthropathy of the elbow. A report of five cases publication-title: J Bone Joint Surg Am contributor: fullname: Jupiter – volume: 17 start-page: 293 year: 2008 end-page: 306 article-title: The fate of elbow arthrodesis: indications, techniques, and outcome in fourteen patients publication-title: J Shoulder Elbow Surg contributor: fullname: Holz – volume: 22 start-page: 428 year: 2008 end-page: 33 article-title: Charcot osteo-arthrpathy publication-title: Curr Orthop contributor: fullname: Collier – volume: 75 start-page: 823 year: 1991 end-page: 6 article-title: Chiari’s description of cerebellar ectopy (1891). With a summary of Cleland’s and Arnold’s contributions and some early observations on neural-tube defects publication-title: J Neurosurg contributor: fullname: Koehler – volume: 18 start-page: 180 year: 2006 end-page: 4 article-title: Syringomyelia: a review publication-title: Semin Spine Surg contributor: fullname: Sandu – volume: 18 start-page: e13 year: 2009 end-page: 6 article-title: Arthrodesis in a neuropathic elbow after posttubercular spine syrinx publication-title: J Shoulder Elbow Surg contributor: fullname: Singh – volume: 37 start-page: 372 year: 1963 end-page: 7 article-title: De arthritide symptomatica of William Musgrave (1657–1721): his description of neuropathic arthritis publication-title: Bull Hist Med contributor: fullname: Kelly – volume: 8 start-page: 141 year: 2007 end-page: 5 article-title: Arthrodesis of the elbow with two locking compression plates publication-title: Tech Shoulder Elbow Surg contributor: fullname: Lim – volume: 7 start-page: 168 year: 2003 end-page: 78 article-title: Anatomy and biomechanics of the elbow joint publication-title: Tech Hand Up Extrem Surg contributor: fullname: Lee – volume: 63 start-page: 1396 year: 1981 end-page: 400 article-title: A new technique of fusion for tuberculous arthritis of the elbow publication-title: J Bone Joint Surg Am contributor: fullname: Arafiles – volume: 12 start-page: 506 year: 2003 end-page: 9 article-title: Syringomyelic neuropathic ulcer of the elbow: treatment with an external fixator publication-title: J Shoulder Elbow Surg contributor: fullname: Wallace – volume: 26 start-page: 1146 year: 2001 end-page: 50 article-title: The effect of simulated elbow arthrodesis on the ability to perform activities of daily living publication-title: J Hand Surg Am contributor: fullname: Stevanovic – volume: 8 start-page: 80 year: 1999 end-page: 5 article-title: Unilateral elbow arthrodesis: the preferred position publication-title: J South Orthop Assoc contributor: fullname: Sharkey – volume: 89 start-page: 533 year: 2006 end-page: 40 article-title: Neuropathic arthropathy of the elbow: a report of two cases publication-title: J Med Assoc Thai contributor: fullname: Waikakul – volume: 41 start-page: E39 year: 2012 ident: bibr6-1758573215598731 publication-title: Am J Orthop (Belle Mead NJ) contributor: fullname: Farzan M – ident: bibr18-1758573215598731 doi: 10.2106/00004623-198163090-00005 – ident: bibr21-1758573215598731 doi: 10.1016/j.hcl.2011.02.002 – ident: bibr4-1758573215598731 doi: 10.1016/j.jse.2009.01.024 – ident: bibr5-1758573215598731 doi: 10.2106/00004623-200106000-00004 – ident: bibr9-1758573215598731 doi: 10.1097/00005131-199708000-00017 – volume: 27 start-page: 194 year: 1981 ident: bibr8-1758573215598731 publication-title: J Postgrad Med contributor: fullname: Bhaskaran R – ident: bibr10-1758573215598731 doi: 10.1016/j.jse.2005.08.019 – ident: bibr19-1758573215598731 doi: 10.1097/BTE.0b013e31812dfb85 – volume-title: Charcot joints year: 1966 ident: bibr13-1758573215598731 contributor: fullname: Eichenholtz SN – ident: bibr17-1758573215598731 doi: 10.3171/jns.1991.75.5.0823 – ident: bibr12-1758573215598731 doi: 10.1007/s00296-003-0389-x – volume: 8 start-page: 80 year: 1999 ident: bibr26-1758573215598731 publication-title: J South Orthop Assoc contributor: fullname: Nagy SM – ident: bibr16-1758573215598731 doi: 10.1053/j.semss.2006.06.008 – ident: bibr22-1758573215598731 doi: 10.1097/00130911-200312000-00008 – ident: bibr14-1758573215598731 doi: 10.1016/j.cuor.2008.08.004 – ident: bibr23-1758573215598731 doi: 10.1016/j.jse.2007.06.008 – volume: 89 start-page: 533 year: 2006 ident: bibr2-1758573215598731 publication-title: J Med Assoc Thai contributor: fullname: Unnanuntana A – ident: bibr11-1758573215598731 doi: 10.1007/s00296-009-1013-5 – ident: bibr25-1758573215598731 doi: 10.1053/jhsu.2001.28940 – ident: bibr15-1758573215598731 doi: 10.3171/2012.11.SPINE12860 – ident: bibr3-1758573215598731 doi: 10.1016/S1058-2746(03)00168-X – volume: 73 start-page: 525 year: 2007 ident: bibr7-1758573215598731 publication-title: Acta Orthop Belg contributor: fullname: Ruette P – ident: bibr24-1758573215598731 doi: 10.1007/s00590-010-0686-5 – volume: 37 start-page: 372 year: 1963 ident: bibr1-1758573215598731 publication-title: Bull Hist Med contributor: fullname: Kelly M – ident: bibr20-1758573215598731 doi: 10.3928/01477447-20140430-04 |
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Title | Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft |
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