A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

N.w.l Schep ,Dennis Den Hartog,Philippe Wittich,Jan Bernard Sintenie,Jos De Haan ,E J M M Verleisdonk ,S.j Ham ,Tom P H Van Thiel ,Inger B Schipper ,M.w.g.a Bronkhorst ,J.p.a.m Vroemen ,J Carel Goslings ,G.i.t Iordens ,W.e Tuinebreijer ,H.g.w.m Meulen ,Steven J Rhemrev ,Mark R De Vries ,Esther M.m Van Lieshout ,A.b Van Vugt ,P Patka ,Gert R Roukema

doi:10.1186/1471-2474-12-130

Abstract

BackgroundElbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation.Methods/DesignThe design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36).DiscussionThe outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator.Trial RegistrationThe trial is registered at the Netherlands Trial Register (NTR1996).

Highlights

Elbow dislocations can be classified as simple or complex
The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with open reduction and internal fixation (ORIF) and additional stabilization with a hinged elbow fixator
The fundamental goal in the management of complex elbow dislocations is the restoration of the osseous-articular restraints

Summary

Introduction

Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. The majority of these complex dislocations is treated with open reduction and internal fixation (ORIF) [3] or primary arthroplasty in case of a non-reconstructable radial head fracture

Objectives

Methods

Conclusion