Chadrabose Rex*, Rameshkumar Periyasamy, Subbachandra Balaji, Premanand C, Shreyas Alva and Shiva Reddy
Corresponding author: Chadrabose Rex email@example.com
Journal of Orthopaedic Surgery and Research 2011, 6:60 doi:10.1186/1749-799X-6-60
(2012-01-10 14:39) Department of Orthopaedic Surgery ,All India Institute of Medical Sciences(AIIMS),
New delhi , India
We read with great interest the manuscript by Rex et al ��Inverted V osteotomy excision
arthroplasty for bony ankylosed elbows�� . I must congratulate the authors for
this study. However, I would like to draw attention of authors and readers to the
1. Nine patients were operated in the study. The primary indication for the procedure
is functional restriction of the patients in seven and both functional limitation
and pain in two patients. A joint immovable from fibrous ankylosis is distinguished
from a joint immovable from bony ankylosis by the fact that, in former, attempts at
motion are productive of pain and subsequently of inflammation: therefore, pain on
attempted motion excludes bony ankylosis.
2. The authors labelled this procedure as excision arthroplasty but there was nothing
excised as such, so it is not an excision arthroplasty in true sense and is simply
3. There is a risk of buttonholing of the bony spike of apex of osteotomy into biceps
and triceps as the patient moves the pseudoelbow joint.
4. Although ulnar nerve was released but no anterior transposition was performed.
As full extension is done, there is definite risk of ulnar nerve neuropraxia, as is
evident in one case of author��s series. This may have been prevented if the authors
performed anterior transposition of ulnar nerve.
Warm regards and once again congratulations for the research.
1. Rex C, Periyasamy R, Balaji S, C P, Alva S and Reddy S Inverted 'V' osteotomy excision
arthroplasty for bony ankylosed elbows. Journal of Orthopaedic Surgery and Research
2011, 6:60 (5 December 2011)
No competing interests.
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