N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and Orthopedics0869-86782658-6738Eco-Vector6344310.17816/vto63443Research ArticleReconstructive surgeries and endoprosthetics of the elbow joint: indications, possibilities and prospectsKesyanGurgen A.<p>MD, PhD, Dr. Sci. (Med.)</p>kesyan.gurgen@yandex.ruhttps://orcid.org/0000-0003-1933-1822Arsen’evIgor G.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist</p>igo23602098@yandex.ruhttps://orcid.org/0000-0003-1801-8383Urazgil’deevRashid Z.<p>MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist</p>rashid-uraz@rambler.ruhttps://orcid.org/0000-0002-2357-124XKarapetyanGrigoriy S.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist</p>dr.karapetian@mail.ruhttps://orcid.org/0000-0002-3172-0161ShuyskiyArtem A.<p>MD, post-graduate student, traumatologist-orthopedist</p>shuj-artyom@mail.ruhttps://orcid.org/0000-0002-9028-3969KesyanOvsep G.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist</p>offsep@yandex.ruhttps://orcid.org/0000-0002-4697-368XLevinAndrey N.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist</p>levin-cito@mail.ruN.N. Priorov National Medical Research Center of Traumatology and Orthopedics1002202228347571603202108042021Copyright © 2021, Eco-Vector2021<p><strong><em>BACKGROUND</em></strong><em>:</em> Severe injuries of the elbow joint and their consequences are a serious problem in modern traumatology and orthopedics due to the large number of unsatisfactory treatment results, in particular, due to the lack of a differentiated approach to the choice of tactics and the method of surgery.</p>
<p><strong><em>AIM</em></strong><em>:</em> To evaluate the results of a differentiated approach to the choice of tactics and the method of surgical intervention in the treatment of patients with injuries and consequences of injuries of the elbow joint.</p>
<p><strong><em>MATERIALS AND METHODS</em></strong><em>: </em>The results of treatment of 245 patients with injuries and consequences of damage to the elbow joint were assessed within 11 years from the date of surgery. Six groups of patients were identified: group 1 osteosynthesis of fractures of the elbow joint; 2nd open arthrolysis without the imposition of Oganesyans hinged distraction apparatus (HDA); 3rd open arthrolysis with the imposition of HDA; 4th arthroscopic arthrolysis without HDA imposition; 5th arthroscopic arthrolysis with the imposition of HDA; 6th elbow arthroplasty.</p>
<p><strong><em>RESULTS</em></strong><em>:</em> In 93% of patients after osteosynthesis (1st group of patients), a good result was obtained (the deficit in the range of motion was not more than 10, the average score on the DASH scale was 8). In patients after arthrolysis, there is a twofold increase in the range of motion (on average from 4250 to 114120), and regardless of the method of arthrolysis (arthroscopic or open) and whether HDA was used or not. On the DASH scale, 89% of patients showed a decrease in points on average from 77 to 36. In the 6th group, an increase in the range of motion was noted on average from 4548 to 126135, on the DASH scale a decrease in points from 7982 to 3944 on average. Revision intervention was required in 28.4%.</p>
<p><strong><em>CONCLUSION</em></strong><em>:</em> The choice of the method of surgical treatment of injuries and the consequences of severe injuries of the elbow joint directly depends on the degree and nature of destruction of the bone-articular and soft tissue structures, the deficit in the range of motion in the joint.</p>elbowelbow jointelbow arthrolysisendoprosthesis elbow jointлокотьлоктевой суставартролиз локтевого суставаэндопротез локтевого сустава[Soldatov YP, Makushin VD. The results of reconstructive surgeries for the elbow ankyloses. Genii ortopedii. 2003;(1):40–43. (In Russ).][Zhabin GI. Travmy loktevogo sustava. In: Kornilov NV, editor. Traumatologiya i ortopediya: rukovodstvo dlya vrachei. St. Petersburg: Gippokrat; 2005. P. 167–218. (In Russ).][Kliuchevsky VV, Hassan Ben El Hafi. The elbow contracture prevention in treatment of humeral distal segment fractures. Genii ortopedii. 2010;(2):74–98. (In Russ).][Mironov SP, Oganesyan OV, Seleznev NV, Khapilin AP. Restoration of elbow function in old forearm dislocation by combined using of arthroscopic technique and hinge-distraction device. N.N. Priorov Journal of Traumatology and Orthopedics. 2006;(1):33–38. (In Russ).][Parker P, Furness ND, Evans JP, et al. A systematic review of the complications of contemporary total elbow arthroplasty. Shoulder Elbow. 2021;13(5):544–551. doi: 10.1177/1758573220905629][Slobodskoi AB, Prokhorenko VM, Dunaev AG, et al. The elbow arthroplasty in young patients. Genii ortopedii. 2015;(2):26–31. (In Russ). doi: 10.18019/1028-4427-2015-2-26-31][Samdanis V, Manoharan G, Jordan RW, et al. Indications and outcome in total elbow arthroplasty: a systematic review. Shoulder Elbow. 2020;12(5):353–361. doi: 10.1177/1758573219873001][Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. Philadelphia: Saunders; 1985. P. 73–91.][Aliev AG, Ambrosenkov AV, Boyarov AA, et al. Midand long-term results of total elbow arthroplasty: post-traumatic consequences and rheumatoid arthritis. Travmatologiya i ortopediya Rossii. 2019;25(1):41–51. (In Russ). doi: 10.21823/2311-2905-2019-25-1-41-51][Kesyan GA, Arsenyev IG, Urazgildeev RZ, Karapetyan GS. Differentiated approach to surgical treatment of the consequences of severe injury of the elbow joint. Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2017;16(4):161–167. (In Russ).][Shuiskiy AA, Kesyan GA, Urazgil’deev RZ, et al. Experience in treatment of distal humeral epimetaphyseal intra-articular fractures using combined osteosynthesis by submersible screws and external fixation hinge distraction system. N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(2):56–62. (In Russ). doi: 10.32414/0869-8678-2018-2-56-62][Kesyan GA, Urazgildeev RZ, Karapetyan GS, et al. Evolution of treatment methods of treatment of intraarticular fractures of the distal metaepiphysis of the humerus (literature review). Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2020;19(3):185–200. (In Russ). doi: 10.37903/vsgma.2020.3.27][Kesyan GA, Urazgildeev RZ, Dan IM, et al. Heterotopic ossification of large joints, as a complication of injuries and diseases of the central nervous system (review). Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2017;16(4):154–160. (In Russ).][Burkhart KJ, Hollinger B. Post-traumatic arthritis in the young patient: treatment options before the endoprosthesis. Orthopade. 2016;45(10):832–843. (In German). doi: 10.1007/s00132-016-3326-x][Cai J, Wang W, Yan H, et al. Complications of open elbow arthrolysis in post-traumatic elbow stiffness: a systematic review. PLoS One. 2015;10(9):e0138547. doi: 10.1371/journal.pone.0138547]