Surgical Release for Tubercular Elbow Stiffness

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2018 Jan 11

PMID 29317839

Citations 1

Authors

Yun Qian

Qixin Han

Wei Wang

Yuanming Ouyang

Weien Yuan

Cunyi Fan

Affiliations

Soon will be listed here.

Abstract

Background: For decades, tuberculosis (TB) has posed a great threat to people worldwide. Bone and joint TB is one of the most common types of extrapulmonary TB, with elbow TB comprising a small proportion of these cases. The treatment for elbow stiffness associated with TB has been rarely reported.

Patients And Methods: We retrospectively analyzed six patients (four females and two males) with tubercular elbow stiffness during a 7-year period. All of them received open arthrolysis and hinged external fixation to restore functional extension, flexion, supination and pronation. Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were evaluated preoperatively and at final follow-up.

Results: At final follow-up after surgery, we evaluated the average active ROM, which was 111.7° (90°-135°). The average extension was 11.7° (0°-30°), while the average flexion was 123.3° (115°-135°). At the same time, the average supination was increased to 70° (40°-90°) and the average pronation was increased to 68.3° (45°-80°). The MEPS was elevated to 92.5 (85-100). Three patients displayed complications and were treated and cured with dressing changes and antibiotics.

Conclusion: Open arthrolysis and hinged external fixation are useful for the treatment of non-traumatic elbow stiffness with TB.

Citing Articles

Tuberculosis of the elbow joint: the complexity of diagnosis and treatment-A case report and review of literature.

Manske J, Tille E, Schlussler A, Biewener A, Nowotny J J Med Case Rep. 2025; 19(1):88.

PMID: 40025616 PMC: 11874434. DOI: 10.1186/s13256-025-05102-8.

Characteristics and management of bone and joint tuberculosis in native and migrant population in Shanghai during 2011 to 2015.

Qian Y, Han Q, Liu W, Yuan W, Fan C BMC Infect Dis. 2018; 18(1):543.

PMID: 30382821 PMC: 6211459. DOI: 10.1186/s12879-018-3456-3.

References

Mansat P, Bonnevialle N, Werner B . [Indications and technique of combined medial and lateral column procedures in severe extrinsic elbow contractures]. Orthopade. 2011; 40(4):307-15. DOI: 10.1007/s00132-010-1666-5. View

Chen S, Yu S, Yan H, Cai J, Ouyang Y, Ruan H . The time point in surgical excision of heterotopic ossification of post-traumatic stiff elbow: recommendation for early excision followed by early exercise. J Shoulder Elbow Surg. 2015; 24(8):1165-71. DOI: 10.1016/j.jse.2015.05.044. View

Baldwin K, Hosalkar H, Donegan D, Rendon N, Ramsey M, Keenan M . Surgical resection of heterotopic bone about the elbow: an institutional experience with traumatic and neurologic etiologies. J Hand Surg Am. 2011; 36(5):798-803. DOI: 10.1016/j.jhsa.2011.01.015. View

Cohen M, Hastings 2nd H . Post-traumatic contracture of the elbow. Operative release using a lateral collateral ligament sparing approach. J Bone Joint Surg Br. 1998; 80(5):805-12. DOI: 10.1302/0301-620x.80b5.8528. View

Aggarwal A, Dhammi I . Clinical and radiological presentation of tuberculosis of the elbow. Acta Orthop Belg. 2006; 72(3):282-7. View

Bornu B, Clement X, Kempf J, Clavert P . Arthroscopic elbow joint release with radial head resection arthroplasty: 12 cases. Orthop Traumatol Surg Res. 2015; 101(6):735-9. DOI: 10.1016/j.otsr.2015.07.009. View

Bele S, Jiang W, Lu H, You H, Fan H, Huang L . Population aging and migrant workers: bottlenecks in tuberculosis control in rural China. PLoS One. 2014; 9(2):e88290. PMC: 3912209. DOI: 10.1371/journal.pone.0088290. View

Zhou Y, Cai J, Chen S, Liu S, Wang W, Fan C . Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elbow Surg. 2017; 26(2):e44-e51. DOI: 10.1016/j.jse.2016.09.019. View

Mulenga H, Tameris M, Luabeya K, Geldenhuys H, Scriba T, Hussey G . The Role of Clinical Symptoms in the Diagnosis of Intrathoracic Tuberculosis in Young Children. Pediatr Infect Dis J. 2015; 34(11):1157-62. PMC: 4604651. DOI: 10.1097/INF.0000000000000847. View

10.

Sandgren A, Hollo V, van der Werf M . Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill. 2013; 18(12). View

11.

Wu X, Wang H, Meng C, Yang S, Duan D, Xu W . Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness. Knee Surg Sports Traumatol Arthrosc. 2014; 23(9):2715-20. DOI: 10.1007/s00167-014-3032-3. View

12.

Kong Y, Subbian S, Cirillo S, Cirillo J . Application of optical imaging to study of extrapulmonary spread by tuberculosis. Tuberculosis (Edinb). 2009; 89 Suppl 1:S15-7. PMC: 4137470. DOI: 10.1016/S1472-9792(09)70006-X. View

13.

Thoreux P, Blondeau C, Durand S, Masquelet A . Anatomical basis of arthroscopic capsulotomy for elbow stiffness. Surg Radiol Anat. 2006; 28(4):409-15. DOI: 10.1007/s00276-006-0114-z. View

14.

Aldridge 3rd J, Atkins T, Gunneson E, Urbaniak J . Anterior release of the elbow for extension loss. J Bone Joint Surg Am. 2004; 86(9):1955-60. DOI: 10.2106/00004623-200409000-00014. View

15.

Chen S, Zhao L, Dong W, Gu Y, Li Y, Dong L . The Clinical Features and Bacteriological Characterizations of Bone and Joint Tuberculosis in China. Sci Rep. 2015; 5:11084. PMC: 4459174. DOI: 10.1038/srep11084. View

16.

Salazar D, Golz A, Israel H, Marra G . Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications. Clin Orthop Relat Res. 2014; 472(7):2269-75. PMC: 4048438. DOI: 10.1007/s11999-014-3591-0. View

17.

Meda Z, Huang C, Sombie I, Konate L, Somda P, Djibougou A . Tuberculosis in developing countries: conditions for successful use of a decentralized approach in a rural health district. Pan Afr Med J. 2014; 17:198. PMC: 4228989. DOI: 10.11604/pamj.2014.17.198.3094. View

18.

Martini M, Benkeddache Y, Medjani Y, Gottesman H . Tuberculosis of the upper limb joints. Int Orthop. 1986; 10(1):17-23. DOI: 10.1007/BF00266268. View

19.

Rao V, Bhat J, Yadav R, Gopi P, Selvakumar N, Wares D . Prevalence of pulmonary tuberculosis among the Bharia, a primitive tribe of Madhya Pradesh, central India. Int J Tuberc Lung Dis. 2010; 14(3):368-70. View

20.

Tobin-West C, Isodje A . Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria. Pan Afr Med J. 2016; 24:60. PMC: 5012801. DOI: 10.11604/pamj.2016.24.60.8497. View