title: Elbow arthrodesis for post-traumatic sequelae: surgical tactics using the Ilizarov frame.
abstract: BACKGROUND
  Surgical arthrodesis of the elbow joint is frequently unsuccessful and rarely performed. It is the purpose of this article to evaluate tactics and different constructs to achieve elbow arthrodesis (EA) using the Ilizarov apparatus in patients with post-traumatic nonreconstructable elbow sequelae.
  
  
  METHODS
  A consecutive series of 4 patients were treated between 2009 and 2013 (3 men and 1 woman; mean age, 46.7 [35-75] years). Two patients had late complications in total elbow replacement and developed nonunion after condylar fractures of the distal humerus. There were 3 ulnohumeral arthrodeses and 1 radiohumeral arthrodesis. The hybrid advanced Ilizarov technique was used in all cases.
  
  
  RESULTS
  Complete union was obtained in 3 EAs (75%) without additional surgery at an average of 23 weeks. Fusion angles ranged from 90° to 120°. One patient required amputation above the elbow because of persistent infection and chronic pain after attempted reconstruction with distraction osteogenesis for infected total elbow replacement with humeral bone loss. The average length of follow-up after EA was 33 months (range, 18-60 months). At final follow-up, the median score of the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire was 42.4 (27.3-52.2). Three patients returned to their working activities.
  
  
  CONCLUSIONS
  EA is not a common orthopedic procedure. Despite its difficulties and need of specific training, the Ilizarov technique provides a reproducible and reliable way of achieving solid fusion with the desired angle. Advantages include infection control, early mobilization, accurate application, convertibility and versatility compared with a monolateral fixator, and improved union rate.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy. Electronic address: sala.francesco@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sala
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Manzoni General Hospital, Lecco, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Catagni
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Manzoni General Hospital, Lecco, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pili
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capitani
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation*; D004185:Disability Evaluation; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D012189:Retrospective Studies; D062707:Return to Work; D000092464:Elbow Injuries
keywords: Elbow; Ilizarov; arthrodesis; external fixator; joint fusion; salvage procedure; surgical technique