Artroplastica di resezione come chirurgia alternativa nel gomito rigido

Backgound. Aim of this paper is to present the technique for the treatment of painful subankylosis of the elbow, as a complication of severe infection, rheumatoid arthritis, and, more frequently, trauma. This technique is a valid alternative to arthrodesis, a procedure with severe functional limitation, and to arthro-prosthesis, which, even now, is often accompanied by secondary complications. Methods. Twelve patients, with an average age of 36 years, were treated with resection arthroplasty, nine were male and three were female. All patients had severe pain and functional limitation with a flexion-extension range of motion between 5 and 35 degree, due to complications from serious fractures. Eleven of the fractures were open; the minimum time between the initial trauma and the final procedure was 2.5 months. Moreover, ten cases developed an infection before coming to our attention and seven of them underwent surgery while still infected. Results. In follow-up, recovery in three cases was evaluated as ''excellent'', six as ''good'', two as ''fair'' and one as ''poor'' (Dee modified classification). Complications included one case of heterotopic ossification and two cases of lateral instability, which required stabilization by orthesis. The best results were obtained in young patients, who participated in an intensive post-operative rehabilitation program without strenuous activity. Conclusions. The conclusion is drawn that this procedure is better indicated than arthrodesis or prosthesis in cases of a concomitant infection, which is resistant to antibiotic therapy. The resection arthroplasty is a valid option for the treatment of elbows with severe limitations, rigidity and pain, secondary to serious fracture, with or without a concomitant infection.