Orthopedics - Oleksa A.P. 2006

Bone and Joint Tuberculosis
Tuberculosis of the Elbow Joint

The elbow joint is affected more frequently than the shoulder; Tuberculosis of the elbow accounts for nearly half of all tuberculous lesions of the upper extremity and roughly 4% of all localizations.

Tubercle bacilli reach the elbow region via Arteries that form a network of terminal branches. Tuberculous osteitis most commonly develops in the olecranon process. The condition may take a slow, granulomatous course or follow a rapidly progressive destructive pattern, which is rarely encountered in clinical practice.

Tuberculous synovitis is more prevalent in children, presenting with a mild clinical course and The formation of free "rice bodies" within the joint. Subchondral foci can impair the Blood supply to the articular Cartilage, precipitating its destruction and resulting in tuberculous Arthritis. Pus from the joint may rupture through either side of the olecranon, forming an abscess detectable by Palpation and aspiration.

Tuberculosis of the elbow typically exhibits a slow, subacute course characterized by pain, elbow Swelling, and restricted range of motion due to an antalgic flexion contracture. Over time, muscular atrophy develops, particularly in the triceps.

Similar manifestations occur when the tuberculous focus is localized at the Base of the coronoid process. If pus breaches the joint cavity, tuberculous arthritis ensues.

When antibacterial therapy is administered in a timely manner, the pathological process gradually subsides, and scarring becomes the predominant mechanism within the joint, resulting in a certain degree of motion restriction.

If destruction of the articular cartilage has occurred, or if an abscess associated with the exudative type of tuberculosis extensively damages the joint, pus may break through the soft Tissues, leading to cold abscess formation.

Treatment. In the Cytology/cytology/16.html">Early stages of the tuberculous process, comprehensive conservative treatment is indicated, consisting of reliable elbow immobilization, administration of anti-tuberculosis therapy, and general supportive care. In the majority of cases, this approach yields highly successful therapeutic outcomes.

Intraosseous periarticular tuberculous foci respond favorably to surgical management. The Procedure involves radical necrectomy followed by filling the bone cavity with antibiotic-impregnated bone grafts.

In cases of severe joint involvement, the Joint Capsule is excised along with foci of tuberculous osteonecrosis, or a classic joint resection with arthroplasty is performed to preserve a functional range of motion in the elbow.

Surgical Technique. Using an arched tissue incision, the ulnar nerve is exposed, encircled with a rubber tape, and retracted anteriorly. The tip of the olecranon is then osteotomized and reflected superiorly along with the detached triceps Muscle. Following the division of the collateral ligaments and joint capsule, the articular cavity is entered. If necessary, the Muscles originating from the humeral epicondyles are subperiosteally detached to improve surgical exposure. The synovial membrane is excised simultaneously with the curettage of tuberculous foci. Next, a semilunar trough is fashioned from healthy bone within the olecranon. The articular end of the humerus is then resected to create a matching contour for the olecranon. The HEAD of the radius is excised. The fit of the olecranon within the humeral recess is tested, ensuring a distinct diastasis between them. The tip of the olecranon and the detached muscles are reattached to their anatomical sites. The collateral ligaments and fibrous joint capsule are sutured. The ulnar nerve is repositioned slightly anterior to its original Location, the wound is drained for 48 hours, and closed in layers. A plaster cast is applied for the duration of wound healing. Mobilization of the elbow is initiated on the eighth or ninth postoperative day. According to S. Malawski (1976), functionally satisfactory upper extremity utility is achieved 3 to 6 months following arthroplasty.

For manual laborers, arthrodesis of the elbow joint in a functionally advantageous position is generally preferred, as a stable arm best suits the demands of their daily lives.