Treatment of Bilateral Elbow Dislocation Using External Fixation With Motion Capacity

Abstract

Bilateral elbow dislocation is a rare injury and only 11 cases are described in the literature, including 8 patients with isolated ligamentous and 3 patients with an additional osseous injury. We present 2 cases of bilateral posterior elbow dislocations treated with a bilateral hinged elbow fixator with motion capacity to allow for early physiotherapy. Both patients had a high-energy trauma with one who fell off a ladder from a 5 m height and the second from a mountain bike injury during off-road biking. All extremities were neurovascularly intact. In the operating room, severe instability was detected in all 4 elbows: after closed reduction in 3 elbows and open reduction in 1 elbow for a Mason type 4 fracture of the radial head that was internally fixed using fine threaded implants, an elbow fixator with motion capacity was applied in all 4 elbows for a period of 6 weeks. One year after surgery, the active range of motion was 0/10/140 degrees of extension and flexion on the right and 0/0/130 degrees on the left side. The second patient achieved 0/0/125 degrees and 0/10/130, respectively. Pro- and supination was full in both patients. All 4 elbows were stable and there were no radiologic signs of degenerative changes at the 1 year follow-up. Treatment of bilateral elbow dislocation using external fixation with early motion capacity allows for active physiotherapy although maintaining joint stability, thus minimizing complications normally associated with the injury. Using this method resulted in an excellent clinical outcome for both patients.