A new technique of fusion for tuberculous arthritis of the elbow

Of eleven patients with tuberculosis of the elbow who were operated on using a new technique, six were followed for two years or more. This technique (which includes debridement and total synovectomy, excision of the radial head, insertion of the triangularly shaped olecranon into a correspondingly shaped hole in the distal end of the humerus, fixation of the humerus and ulna with a single screw, medial and lateral epicondylectomy, and anterior transposition of the ulnar nerve) provides superior bone contact and firm internal fixation without the need for bone grafts. Solid fusion resulted in the six patients who were followed for two years or more. The only complications observed in all eleven patients were transient ulnar-nerve hypoesthesia in one patient and a tourniquet paralysis in an other, both of which resolved. The advantages of the procedure are that the fixation is stable; bone-grafting is not required; adequate joint débridement, including anterior synovectomy, is possible after the radial head is excised; and to date no pseudarthrosis has occurred.