External fixator of the elbow

Abstract

The placement of an external elbow fixator can be statically carried out as temporary stabilization or as a hinged movement fixator. As a hinged movement fixator a functional follow-up treatment is possible due to control of the joint guidance and reduction of the compromising forces on the osteoligamentous structures. As atemporary stabilization of the elbow, the external fixator is used as adamage control method. As a movement fixator it is used as an additional protection and movement control after complex osteoligamentous interventions and persisting tendency to dislocation of the joint and also as a standalone procedure. In some cases, the procedure is also used in distraction arthrolysis of stiff elbows and as asalvage procedure in patients with relevant comorbidities as part of fracture treatment. Inexperience in relation to the procedure as well as alocal acute infection at the level of the intended pin locations should specifically be mentioned as contraindications. In addition, compliance and patient understanding of the procedure are essential for the success of treatment. Soft tissue preparation for pin placement should be preferred over percutaneous incisions to enable asafe bone exposure. Knowledge of the course of neurovascular structures (particularly the radial nerve) is essential. When placing ahinge, knowledge of the position and detection of the idealized center of rotation is of fundamental importance. The type of postoperative management required essentially depends on the underlying injury. When placing ahinged fixator, the aim is to enable movement as early as possible. Nevertheless, blocking of the hinged fixator may be useful for ashort period of time. Adequate pin care over the duration of the treatment is essential in order to prevent complications. Good functional results have been reported for the treatment of unstable elbows after primary and secondary placement of ahinged external fixator. Good functional scores and improvement in the range of motion were also recorded in the context of an arthrolysis (additive for open arthrolysis or distraction arthrolysis); however, in contrast asignificant number of complications associated with this surgery are likely to emerge. As adefinitive salvage procedure, satisfactory results were obtained in asmall case series of aselected older patient group with relevant comorbidities.