Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness

Background: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA.

Method: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20.

Results: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2-168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001).

Conclusion: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.