Elbow arthrodesis (EA) is rarely performed in orthopaedic surgery and indicated only as a salvage procedure.

Historically, EA was performed for tuberculous septic elbow arthritis, with about 50% successful rate of primary fusion.⁸,¹⁹

With modern techniques, especially compression plating, primary fusion rates have improved somewhat from 50% to 86%,⁹,¹⁰,¹⁶ with final fusion rates including reoperation ranging from 83% to 100%.⁶,⁹,¹⁶

Reoperation for nonunion, infection, wound healing complications, and hardware prominence is common (average 1.4 to 1.6 reoperations per patient).⁹,¹⁶

EA results in greater functional disability than arthrodesis of the ankle, hip, or knee joints.

Loss of motion in the elbow is disabling and can only be partially compensated by trunk, shoulder, forearm, and wrist motion.⁴,¹²

Skin and soft tissue defects are evaluated.

The quality and quantity of bone available for fusion are assessed.

The surgeon should anticipate the need for bone graft or soft tissue coverage preoperatively.

If soft tissue coverage is necessary, a plastic surgery consultation is recommended.

Shoulder, forearm, wrist, and spinal column motion is evaluated.

Neurologic and motor deficits are documented.

Blood flow to the hand is determined.

Standard orthogonal radiographs of the elbow are obtained.

Computed tomography (CT) scans of the elbow are obtained for more detailed bony anatomy.

If infection is suspected:

The elbow is one of the most difficult joints to fuse because of the long lever arm and strong bending forces across the fusion site.

EA should be considered a salvage procedure when no other satisfactory surgical option exists. The patient should be counseled regarding the high rate of complications.