Purpose: In the hands of the conceptors, total elbow prostheses (TEP) have provided favourable results. The purpose of this work was to evaluate our own results in a consecutive series of GSBIII TEP in order to confirm or infirm the mid-term reliability of these prostheses

Material and methods: Over a ten year period, 20 GSBIII TEP were implanted by two operators in 17 patients. The same technique and approach were used in all cases. The patients were reviewed by an independent investigator 12 to 128 months after surgery (mean follow-up 4.3 years). We noted pre- and postoperative pain and motion and recorded the Morrey function score. Patient satisfaction was noted at last follow-up. The Morrey radiological classification (4 stages) was used. The position of the TEP, its stability and its evolution were studied.

Results: Mean age was 51 years (range 19–66) and the underlying rheumatoid polyarthritis had progressed for a mean 14 years. The main indication was pain (mean preoperative visual analogue evaluation = 7/10) All elbows were in stage 3 or more radiographically. At last follow-up, mean pain was 0.3/10 and the function score had improved from 11/25 to 24/25. Gain in motion was 49° in flexion-extension and 42° in pronosupination. Mean satsifaction was scored 8.85/10 and was related to joint motion. At the last follow-up radiological assessment, we found localized metaphyseal bone resorption in three elbows, humeral lucent lines in five, ulnar lucent lines in two (all measuring less than 1 mm, partial and unchanged). There were no neurological, cutaneous or infectious complications. Rate of survival was 100%.

Discussion:At mid-term, we had very favourable results for pain relief and function as well as patient satisfaction. The gain in joint motion was less with a mean extension defect of 20° and was closely related to patient satisfaction.

Conclusion: Our study confirms that this TEP model provides reliable and stable results: no clinical complications were observed during the follow-up nor any loosening. Patient satisfaction was less if the elbow was stiff but with little pain.

Purpose: Serratus anterior palsy is usually part of a Parsonnage and Turner syndrome. When occurring alone, it may be secondary to compression of the long thoracic nerve. The anatomic point of contact has been described at the level of the second rib. We report our experience with a musculofascial serratus anterior flap showing that the crossing point of the long thoracic nerve and the thoracic branch of the thoracodorsal artery, the serratus anterior fascia could also be a potential point of compression.

Material and method: We cared for two patients with complete and isolated palsy of the serratus anterior. In the first patient, the paralysis developed over one year and in the second had started three months before treatment. In both patients, the preoperative electromyogram showed an absence of serratus anterior activity. We therefore performed exoneurolysis of the long thoracic nerve in both cases. At surgery, the nerve was clearly compressed at the point where the long thoracic nerve crossed the thoracic branch of the thoracodorsal artery.

Results: The first patient recovered normal muscle activity one year after surgery. Complete recovery was achieved in the second patient at three months.

Discussion: These two cases would support the hypothesis that the long thoracic nerve can become compressed within the serratus anterior fascia. In all cases with serratus anterior palsy secondary to suspected mechanical compression, we propose exoneurolysis of the long thoracic nerve.