Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow

Abstract

Purpose To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation. Methods Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoid process and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process. Results At an average follow-up period of 57 months stability was restored in every patient. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 and the average Mayo score was 84, with 6 excellent, 4 good, and 3 fair results. The average arc of ulnohumeral motion was 99°. Six patients had radiographic signs of arthrosis including 5 of 6 patients with olecranon fracture-dislocations. Conclusions A stable, functional elbow can be restored in most patients with persistent instability after fracture-dislocation of the elbow using a treatment protocol incorporating hinged external fixation.