Salvage-Verfahren zur Vermeidung der Ellenbogenprothetik in der posttraumatischen Situation

While elbow arthroplasty usually provides predictable pain relief and joint range of motion, concerns exist regarding postoperative activity limitations and implant survival. Therefore, these procedures are limited to select subsets of patients, typically low-demand and elderly patients. Is it possible to define generally valid guidelines for “salvage procedures” in young patients to avoid elbow arthroplasty? There is often discordance between the clinical manifestations and radiological findings. In less severe injuries, characterized by moderate cartilage damage, open reduction with reconstruction of the stabilizing bony structures is warranted (fixation or reconstruction of the coronoid process, radial head fixation or replacement) with on-demand reconstruction of the ligaments, most notably the lateral collateral ligament. The intervention is usually not sufficient to prevent the progression of the osteoarthritic lesions but can ensure satisfactory function for a prolonged time. Surgical treatment options as well as “second line of defense” strategies are demonstrated based on selected cases. Treatment strategies should be individualized and must consider the specific underlying pathology. There is no simple single solution or a universally valid guideline, but joint-preserving strategies are becoming more and more important for selected young patients. The presented procedures do not represent a panacea for all pathological conditions of the radiocapitellar or proximal radioulnar joint but offers one additional measure for surgeons facing these difficult problems. The presented procedures are limited to select subsets of young, symptomatic patients. The treatment objective is to achieve minimal pain, promote joint function, and delay arthroplasty for as long as possible.