Tuberculosis of the elbow joint in children: a review of ten patients who were managed nonoperatively.
BACKGROUND
There is scarce information regarding osteoarticular tuberculosis of the elbow in children, even in countries where tuberculosis is endemic. We report our experience with ten patients who were managed nonoperatively.


METHODS
We retrospectively assessed ten children with elbow tuberculosis with regard to their presentation, diagnosis, management, response to standard antitubercular drugs, and outcome at the completion of antitubercular therapy. All patients were managed nonoperatively with splinting for as long as six weeks, followed by mobilization along with multidrug antitubercular medication for twelve months.


RESULTS
Swelling of the elbow that did not respond to initial treatment was the most common cause for referral to our clinic. The proximal ulnar metaphysis was most commonly involved. The average duration of follow-up was twenty-six months. The average time for healing of draining sinuses was twelve weeks (range, four to fourteen weeks). Lytic lesions, including coke-like sequestrum, healed radiographically at an average of 7.4 months (range, six to nine months). Range of motion improved with treatment, but some motion restriction always persisted, depending on the extent of joint destruction.


CONCLUSIONS
In the Indian subcontinent, the presentation of elbow tuberculosis is usually exudative with abscess formation, and the disease is fairly advanced at the time of diagnosis. An "ice cream scoop" appearance of the proximal part of the ulna in children should raise suspicion for tuberculosis. Elbow tuberculosis in children can be treated adequately with use of nonoperative means, regardless of the extent of osseous destruction, with a good outcome.
Agarwal
Anil
A
Department of Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India-110031. rachna_anila@yahoo.co.in
Mumtaz
Imran
I
Kumar
Pawan
P
Khan
Shariq
S
Qureshi
Nadeem Aktar
NA
D000995:Antitubercular Agents / Q000627:therapeutic use; D050280:Arm Bones / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000382:microbiology; D007223:Infant; D008297:Male; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000382:microbiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013165:Splints; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging / Q000628:therapy*; D014457:Ulna / Q000000981:diagnostic imaging / Q000382:microbiology
D000995:Antitubercular Agents; D006454:Hemoglobins