Paper 91: Surgical Management of Unstable Elbow Dislocation without Intra-articular Fracture: Surgical Findings and the Results of Early Stabilization and Mobilization in 20 Patients

Abstract

The evaluation and management of unstable elbow dislocation with persistent subluxation after closed reduction remains variable and controversial. The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilization in unstable elbow dislocations with pure capsuloligamentous injuries. Twenty consecutive patients presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Clinical information, radiographs and intraoperative findings were collected. Anatomic repair was performed using metal anchor screws and bone tunnel method. All patients returned for radiographs and functional evaluation with use of Mayo Elbow Performance Score at a minimum of 24 months after the operation. Ligament avulsion is noted in 55 % for MCL, 80% for LCL, 60% for flexor tendon, 80 % for extensor tendon. Some injury patterns had a high association of brachialis and anterior capsular injury. Overall mean functional Mayo Elbow Performance Score was 93.2. Concentric stability as measured clinically and radiographically was achieved in the elbows of all patients. Brachial artery injuries occurred in two elbows. Heterotopic calcification of the joint capsule and collateral ligaments was noted in 14 patients (70%) and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with an early rehabilitation in acute unstable elbow dislocation provided satisfactory outcomes at two to four year postoperatively.