Concomitant internal joint stabilizer augmentation with isometric lateral ulnar collateral ligament repair for unstable elbow dislocations: a surgical technique

Abstract

Complex unstable elbow fracture dislocations can be a challenging pathology to treat for orthopedic surgeons. Historical treatment methods of persistent elbow instability after bony and ligamentous pathology have been addressed include prolonged immobilization, trans-articular pinning, and static or hinged external fixators. However, they can be associated with significant complications and unacceptable rates of unsatisfactory clinical outcomes. As a result, a movable internal fixator known as an internal joint stabilizer (IJS) was developed to help mitigate these complications. The IJS, when utilized, often is inserted at the origin of the lateral ulnar collateral ligament (LUCL). The rotating humeral pin of the IJS must be placed in the elbow’s center axis of rotation at the distal humerus to function properly. The competition for the same footprint makes concomitant anatomic repair of the LUCL challenging. This paper seeks to describe a surgical technique that allows for isometric humeral pin placement of the IJS without sacrificing the ability to restore the LUCL to its anatomic footprint by combining the LUCL suture anchor and IJS humeral pin sites.