Augmented primary sutures "internal bracing" following ligamentous elbow dislocation

Abstract

Aim of surgical treatment is the primary stabilization of the unstable elbow following aligamentous elbow dislocation. Ligamentous elbow dislocations are typically accompanied by injuries to the surrounding musculature and collateral ligaments of the elbow joint. Surgical treatment is indicated in case of failure of nonoperative therapy, i.e., when adislocation can only be prevented in immobilization > 90° and pronation of the elbow or an active muscular centering of the elbow fails after 5-7days. Contraindications for asolely "internal bracing" augmented primary suture are generally in the case of accompanying bony injuries in elbow dislocations, extensive soft-tissue injuries, and septic arthritis of the elbow. The augmented primary suture of the elbow is performed using both alateral (Kocher or Kaplan) and medial (FCU split) approach to the elbow. After reduction of the elbow, the collateral ligaments are first augmented with high-strength polyethylene suture and fixed in the distal humerus together with another high-strength polyethylene augmentation suture. The extensors and flexors are then fixed to the medial and lateral epicondyle, respectively, using suture anchors. The aim of the postoperative management is early functional exercise of the elbow. The elbow is placed in an elbow brace to avoid varus and valgus load. Between August 2018 and January 2020, atotal of 12patients were treated with an augmented primary suture following unstable ligamentous elbow dislocation. After amean follow-up of 14 ± 12.7months, the mean Mayo Elbow Performance Score was 98.5points with amean functional arc of 115°. None of the patients reported arecurrent dislocation or persistent instability of the elbow.