Excision arthroplasty elbow : some concerns Sanjay Meena, Department of Orthopaedic Surgery ,All India Institute of Medical Sciences(AIIMS), New delhi , India 10 January 2012 Dear Sir, 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 following: 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 an osteotomy. 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. Refrences: 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) Competing interests No competing interests.