RT Journal
A1 Agarwal, Anil
A1 Mumtaz, Imran
A1 Kumar, Pawan
A1 Khan, Shariq
A1 Qureshi, Nadeem Aktar
T1 Tuberculosis of the Elbow Joint in ChildrenA Review of Ten Patients Who Were Managed Nonoperatively
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2010
FD February 1
VO 92
IS 2
SP 436
OP 441
DO 10.2106/JBJS.I.00805
UL http://dx.doi.org/10.2106/JBJS.I.00805
AB Background: 
  There is scarce information regarding osteoarticular tuberculosis of the elbow in children, even in countries where tuberculosis is endemic. We report our experience with ten patients who were managed nonoperatively.Methods: 
  We retrospectively assessed ten children with elbow tuberculosis with regard to their presentation, diagnosis, management, response to standard antitubercular drugs, and outcome at the completion of antitubercular therapy. All patients were managed nonoperatively with splinting for as long as six weeks, followed by mobilization along with multidrug antitubercular medication for twelve months.Results: 
  Swelling of the elbow that did not respond to initial treatment was the most common cause for referral to our clinic. The proximal ulnar metaphysis was most commonly involved. The average duration of follow-up was twenty-six months. The average time for healing of draining sinuses was twelve weeks (range, four to fourteen weeks). Lytic lesions, including coke-like sequestrum, healed radiographically at an average of 7.4 months (range, six to nine months). Range of motion improved with treatment, but some motion restriction always persisted, depending on the extent of joint destruction.Conclusions: 
  In the Indian subcontinent, the presentation of elbow tuberculosis is usually exudative with abscess formation, and the disease is fairly advanced at the time of diagnosis. An "ice cream scoop" appearance of the proximal part of the ulna in children should raise suspicion for tuberculosis. Elbow tuberculosis in children can be treated adequately with use of nonoperative means, regardless of the extent of osseous destruction, with a good outcome.Level of Evidence: 
  Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.