Chronic Elbow Dislocation Research Articles

Innovative method of Intervention: Modified-Internal Joint Stabilizer-Elbow for Acute and Chronic Elbow Dislocation

Innovative method of Intervention: Modified-Internal Joint Stabilizer-Elbow for Acute and Chronic Elbow Dislocation

Open Arthrolysis for Chronic Elbow Dislocation with Extremely Severe Stiffness in Children.

Studies on extremely severe elbow stiffness after chronic dislocation in children are scarce. This study aims to investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. All children performed passive functional exercises the day after surgery. The elbow flexion and extension angles, range of motion (ROM), and Mayo score were evaluated preoperatively and at the final follow-up. Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow-up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). The MEPS at the final follow-up was 78.57 ± 14.24, which was significantly higher than preoperative (29.76 ± 10.89), and the excellent rate was 81%. Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children.

Total Elbow Arthroplasty in Young Patients - An 8-Year Follow-up Case Series.

Certain elbow pathologies can give rise to considerable loss of joint function, which would severely affect the daily living activities of the patients. Total elbow arthroplasty (TEA) can be a safe and reasonable motion-preserving and pain-relieving option in such debilitating elbow conditions. The aim of this case series is to evaluate the functional outcome of TEA in young patients with four different indications after an 8-year follow-up. We report a case series of four TEA cases done for different indications, namely rheumatoid arthritis, chronic elbow dislocation, post-traumatic elbow ankylosis, and failed primary total elbow replacement, all in relatively young patients. All patients were given a semi-constrained Coonrad-Morrey prosthesis using a posterior Bryan-Morrey approach. The cases were done during the years 2013-2014. Eight-year follow-up of each case showed excellent functional outcome and persistent pain relief with a high Mayo Elbow Performance Score. All the patients have given written consent for publishing this article. Despite being uncommon, total elbow replacement can be the choice of surgery for certain elbow affections, giving satisfactory functional recovery and good pain relief, even in a younger population.

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation.

The task of achieving a good clinical outcome on patients with chronic elbow dislocation is arduous. Any stabilization method used should be robust enough in order to allow for early elbow motion. Immobilization of the elbow for a prolonged time period may lead to stiffness and heterotopic ossification. Several methods of ligament reconstruction have tried to address the global instability that is present in such scenarios. We describe a technique of reconstructing both bands of the medial ligament, and the lateral ulnar collateral ligament of the elbow, by using a looped tendon graft and reinforcing the lateral side with nonabsorbable tape and anchors. The graft is passed as a loop once through the humerus and ulna, recreating the anterior portion of the medial collateral ligament and the lateral ulnar collateral ligament. Then the lateral side is augmented with the tape and anchors and the loop is fixed. Lastly, the medial tail of the graft is used in order to recreate the posterior part of the medial ligament. This technique uses a single graft along with nonabsorbable tape and anchors to make a robust construct that will withstand early range of motion, without jeopardizing elbow stability. Potential complications include damage to the ulnar nerve, infection, elbow stiffness, or persistent instability in complex cases with bone involvement.

Interposition Arthroplasty in Untreated Chronic Dislocation of the Elbow.

Objective:To describe the clinical outcomes of interposition arthroplasty with transposition of the medial epicondyle to the coronoid process and articulated external fixation in patients with untreated chronic dislocation of the elbow.Methods:Fourteen consecutive patients diagnosed with untreated chronic elbow dislocation performed a complete radiological and physical examination. The same surgeon treated all patients with a same technique. Passive mobilization started immediately in addition to the vigorous care of the surgical wound and surrounding skin.Results:A total of 14 patients were treated, with a mean age of 31 years, with the nondominant side being the most affected (65%). In the immediate postoperative period, the initial Mayo Elbow Performance Score was 60 pts. In all cases, the distraction from the articulated fixator was removed, and there was an average of 16 pts improvement at the time of removal. A hinged elbow orthosis was placed for 4 weeks starting strengthening and obtained radiographic integration of the neocoronoids; ranges of motion of flexion 122°, extension −6°, and pronosupination 70°, without data of any direction instability.Conclusion:Considering that this is one of the longest series with a follow-up of more than 60 months of evolution in our patients, the result is completely satisfactory, achieving the objective of a minimum range of motion of 100° in addition to elbow stability.

The internal joint stabilizer for chronic elbow dislocation: a surgical technique

The main goal of treatment for chronically unreduced elbow dislocations is to restore a stable, concentric joint and regain a satisfactory arc of motion. Due to the conflicting goals of restoring elbow stability and regaining a good arc of motion, the treatment of chronic elbow dislocation remains a challenge for even the experienced orthopedic surgeon. The standard treatment of these dislocations consists of open reduction, V-Y muscleplasty of the triceps, and temporary arthrodesis or cast immobilization. However, prolonged postoperative immobilization may result in elbow stiffness, which significantly limits the functional outcome. We present our surgical technique with a focus on restoring stable reduction such that early motion can be instituted and complications of prolonged immobilization can be avoided. From position to wound closure, surgical steps are presented in detail, with pearls for practice and a discussion on chronic elbow dislocation. The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations. This reproducible surgical technique allows for stability and early mobility while having the added benefit of circumventing complications associated with prolonged immobilization and hinged external fixation. Understanding the surgical indications, as well as the nuances of the surgical technique utilizing the internal joint stabilizer, is critical in order to improve patient outcomes and avoid complications.

A case series of chronic elbow dislocations treated with open reduction without formal reconstruction or augmentation of ligaments using collateral approach

Elbow joint serves important functions for the purpose of carrying out routine activities. Chronic dislocations of this joint block the smooth functioning of the elbow joint, thus hampering patient’s self-care and making day to day tasks difficult to perform. Chronic elbow dislocation is defined as a dislocation that has remained unreduced for 2 weeks. The extensive soft-tissue fibrosis and contractures along with skeletal changes that develop during this time usually prevent successful closed reduction. A total of 3 patients with chronically dislocated elbow joints were enrolled in the case series and were managed with the similar technique of open reduction of delivering out the distal humerus out and reduction without any formal reconstruction or augmentation of any of the ligaments by the same surgeon in the same hospital set up followed by the same post operative rehabilitation protocol. All the patients achieved considerably good, stable and painless elbow joint with significant improvement in range of motion as compared to pre operative one. The outcomes were measured using mayo elbow score (MEPS). Conclusion: This technique of treating elbow joint dislocation is very effective and gives patient a clinically stable, painless and mobile elbow joint. The results were evaluated with the Mayo elbow performance score (MEPS) which showed a considerable improvement in post-surgery score as compared to pre surgery one.

Treatment of a Chronic Elbow Dislocation With an Internal Fixator.

There are a variety of ways to treat chronic elbow dislocations, including repeat closed reduction and immobilization, transarticular pinning, temporary bridge plating, hinged or rigid external fixation, and internal fixator application. Although each have distinct advantages and disadvantages, avoiding recurrent instability is critical. The internal-fixator is a relatively new option to maintain a stable, concentric reduction and facilitate early range of motion. This article and accompanying video describe the surgical technique of using an internal joint stabilizer for treatment of a chronically unstable ulnohumeral joint.

Open Reduction on very late-presenting unreduced posterior elbow dislocation: Still promising treatment option

BackgroundNeglected dislocation of the elbow is associated with instability, pain, and limitation of elbow function. In developing countries, neglected dislocations of the elbow are quite common, and most patients initially go to local bonesetters, which only aggravates the problem. Presentation of caseTwo patients with a history of unreduced posterior elbow dislocation for more than 1 year and were treated by a traditional bonesetter were included in this case study. The first case was a 65-year-old female with a history of injury around her right elbow around 12 months before admission. The patient underwent open reduction with triceps lengthening and immobilization with plaster of paris for 3 weeks. The second case was a 53-year-old male with a history of injury caused by a fall on an outstretched hand around 18 months before admission. The patient underwent arthrolysis followed by triceps lengthening, internal fixation with transarticular k-wire, and immobilization with elbow slab for 3 weeks. DiscussionTo optimize treatment goals and patient function, various surgical approaches have been described for treating chronic elbow dislocations. The benefit of the VY triceps lengthening is to simplify the reduction procedure, especially in the elbow dislocations with greater chronicity. The downside of the VY lengthening is possible triceps weakness, delayed physiotherapy, and increased postsurgical pain. On the basis of this study, open reduction should remain a treatment option for patients regardless of age and chronicity of injury. ConclusionOperative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable, and functional limb.

Outcome of Neglected Elbow Dislocation Treated with Open Reduction at Rural Tertiary Care Hospital in Nepal.

Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications.

Long standing forearm dislocations

Dislocations that remain unreduced for 3 weeks or more, are called the chronic elbow dislocation. Today they are found quite rarely. Objective: to study the probable causes of long standing forearm dislocations, to analyze medical tactics and results of treatment. Methods: we used the data of clinical observations of 5 patients (2 men, 3 women), mean age (38 ± 8) years with long standing forearm dislocations. All patients had surgical treatment. Results: the cause of the long standing dislocations occurrence, in 2 cases there was a violation of medical recommendations by patients, in 3 — insufficient medical control, absence of control radiography after immobilization, lack of timely correction of the patient's management, erroneous the choice of conservative treatment tactics in the presence of indications for surgery. Features of treatment tactics depending on the characteristics of dislocations were analyzed. Comparative data of the joints function are given: the amplitude of flexion/extension movements before the surgery was 25° ± 6°, after — 108° ± 5°; assessment of the limb function according to Mayo Elbow Performance Index before the surgery was equal to (23 ± 5) points, in the follow-up period (17 ± 2) months) — (81 ± 7) points (p < 0.001). Conclusions: in the case of long standing posterior dislocations, open reduction of the forearm can be performed from the lateral approach with restoration of injuried ligaments, in the case of posterior-lateral — it is advisable to use posterior approach, which allows for more complete arthrolysis, tissue mobilization, restoration of ligaments, as well as perform neurolysis, transposition of the ulnar nerve. In case of short terms of long standing forearm dislocation it is possible to manage a temporary fixation of the joint with one or two wires, passed through the joint and external fixation with a plaster cast for a period of 15 up to 30 days with subsequent mobilization without the use of external fixation devices.

A case of chronic elbow dislocation treated by open reduction through bilateral extensile approach

A case of chronic elbow dislocation treated by open reduction through bilateral extensile approach

Functional outcomes following surgical treatment of chronically unreduced simple elbow dislocations : a retrospective review

Background: Chronic elbow dislocations are rare injuries that present late for orthopaedic management. The delay in presentation is frequently due to patients not seeking treatment after the initial injury, poor access to health care, inadequate initial treatment of acute dislocation or initial missed diagnosis. Chronic simple elbow dislocations refer to dislocations that remain unreduced for more than two weeks and are not associated with fractures. This study aims to evaluate the outcome of surgically treated chronic elbow dislocations. Methods: A retrospective review of all patients who were treated for chronic simple elbow dislocations between September 2009 and August 2014 was undertaken. Further information regarding return to function was obtained from the records or telephonic consultation with the patients. Nine patients were included for final analysis. Results: Nine patients were eligible for the study. Three patients were employed, three were scholars and three were unemployed. All patients were able to return to premorbid function with minor limitations due to occasional pain. According to the Mayo Elbow Performance Index (MEPI) score, two patients had excellent outcomes, three good and three fair. One could not be scored as there was no recorded scoring on the file and telephonic contact was unsuccessful. The range of motion varied from 20° of extension to 140° of flexion. One patient developed a stiff elbow but was able to adapt to activities of daily living. Conclusion: Surgical treatment of chronically unreduced simple elbow dislocations offers satisfactory outcome with minimal complications and should be considered for all patients presenting with this condition. Level of evidence: Level 4

The burden of chronic elbow dislocations in Cambodia and early results of a cost-effective surgical approach.

Chronic elbow dislocation presents a surgical challenge and there is difficulty in balancing stability with early mobilisation. We present a series of 103 patients treated with open reduction via a posterior approach and provide early results of an alternative combined medial and lateral approach (Soddo technique, Anderson etal.). Of the 103 patients, 81% initially consulted a traditional healer and the mean dislocation period was 11 weeks. There was significant loss to follow-up. Only 12 patients having undergone the posterior approach had complete datasets. The mean preoperative arc of movement was 10° and the postoperative arc was 65° at a mean follow-up of 16 weeks. Five patients treated with the Soddo technique had sufficient follow-up data. The mean preoperative arc was 20° and the mean postoperative arc was 95° (mean follow-up of 20 days). Those having undergone the Soddo technique achieved a 20° greater increase in range of movement and no re-dislocations.

Total Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation: 全肘關節置換對患有長期肘關節脫位的遠端肱骨骨折提供良好的功能結果

Distal humerus fracture with concomitant chronic elbow dislocation is difficult to manage by open reduction and internal fixation, while total elbow arthroplasty (TEA) is an effective treatment for acute fracture or failed internal fixation of distal humerus fracture in elderly patients with osteoporosis. We present a case of an 86-year-old woman who suffered from acute distal humerus fracture in the presence of chronic elbow deformity from elbow dislocation since childhood at the age of 10 years. This was treated with TEA using Coonrad/Morrey prosthesis with long stem and long flange humerus components and cerclage wiring of humeral condyle. Postoperatively, elbow mobilization was started early within a hinged elbow brace. There was no operative complication. At the last follow-up 22 months after surgery, there was no pain and good elbow motion (20–130° flexion–extension arc, full supination and pronation to neutral) was obtained. The Mayo Elbow Performance Score was 100. There was incorporation of the bone graft at the anterior flange with no radiographic loosening of the prosthesis. This case shows that TEA can yield a gratifying clinical result and efficiently resolves two problems with one solution.

Functional outcomes following surgical treatment of chronically unreduced simple elbow dislocations: a retrospective review

Background: Chronic elbow dislocations are rare injuries that present late for orthopaedic management. The delay in presentation is frequently due to patients not seeking treatment after the initial injury, poor access to health care, inadequate initial treatment of acute dislocation or initial missed diagnosis. Chronic simple elbow dislocations refer to dislocations that remain unreduced for more than two weeks and are not associated with fractures. This study aims to evaluate the outcome of surgically treated chronic elbow dislocations. Methods: A retrospective review of all patients who were treated for chronic simple elbow dislocations between September 2009 and August 2014 was undertaken. Further information regarding return to function was obtained from the records or telephonic consultation with the patients. Nine patients were included for final analysis. Results: Nine patients were eligible for the study. Three patients were employed, three were scholars and three were unemployed. All patients were able to return to premorbid function with minor limitations due to occasional pain. According to the Mayo Elbow Performance Index (MEPI) score, two patients had excellent outcomes, three good and three fair. One could not be scored as there was no recorded scoring on the file and telephonic contact was unsuccessful. The range of motion varied from 20° of extension to 140° of flexion. One patient developed a stiff elbow but was able to adapt to activities of daily living. Conclusion: Surgical treatment of chronically unreduced simple elbow dislocations offers satisfactory outcome with minimal complications and should be considered for all patients presenting with this condition. Level of evidence: Level 4

A study on clinical outcome of total elbow arthroplasty

Introduction: Prosthetic total elbow arthroplasty (TEA) is a recognised treatment for the painful arthritic elbow. is a challenging procedure for orthopedic surgeons. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The clinical outcome and long-term survivorship differs from implant to implant, and the results obtained with a given linked or unlinked implant cannot be extrapolated to other members of the same implant family.Materials and Methods: 13 cases of total elbow arthroplasty were included in this study, between June 2010 and October 2013. The indications for total elbow arthroplasty in this study were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. Patients with compound fracture around the elbow joint, severely comminuted fracture proximal ulna, flaccid paralysis of the upper limb, non-restorable function of biceps or triceps and patients with high demanding jobs have been excluded from the study. Results: The average operative time was 86.2 minutes (range 64 to 108 minutes). The follow up was from 4 months to 110 months (mean 71 months). The evaluation of the patients was based on clinical as well as on radiological parameters. Pre-operatively four patients had stable elbows as they had ankylosis in non-functional position between 80 to 90° due to rheumatoid arthritis or traumatic arthritis and also stable by virtue of bony fusion. Remaining nine patients had unstable elbows because of fracture distal humerus. Clinico‑radiologically all the elbows were stable. Conclusion: To conclude, a semi constrained total elbow arthroplasty is a predictable and effective method for decreasing pain and restoring function in elderly patients with chronic elbow dislocation or fracture dislocation. The rapid functional improvement provided by this procedure allows patients to return to activities of daily living early.

Chronic Elbow Dislocation Treated with Ligament Reconstruction: A Case Report

Chronic Elbow Dislocation Treated with Ligament Reconstruction: A Case Report

Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results.

To describe the surgical treatment and patient outcomes of chronic elbow dislocations. Retrospective review. Two tertiary referral centers. All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015. Review of patient demographics, injury chronicity, surgical technique, and patient outcomes. Clinical outcomes included elbow range of motion and complications. Radiographic outcomes included the presence of heterotopic ossification. Patient-reported outcomes included the Mayo Elbow Performance Index (MEPI) and the Summary Outcome Determination (SOD). Thirty-two patients with mean follow-up of 22 months (range, 13-41 months) were included. The mean dislocation duration was 6 months (range, 1-34 months). The mean preoperative range of motion was 8 degrees (range, 0-30 degrees). There were no infections or recurrent dislocations. One patient developed transient ulnar nerve palsy postoperatively. There were no cases of new or progressive heterotopic ossification. The mean postoperative extension was 31 degrees (range, 0-75 degrees), and the mean postoperative flexion was 132 degrees (range, 95-150 degrees); the mean final arc of motion was 101 degrees (range, 50-140 degrees). The mean postoperative MEPI was 93 (range, 70-100), and the mean SOD score was 9 (range, 6-10). Using the MEPI, 97% (31/32 patients) had good or excellent outcome. There was no difference in flexion/extension arc or MEPI scores between groups of elbows older and younger than 17 years or dislocations less or more than 3 months. This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Chronic Elbow Dislocation: Evaluation and Management.

Chronic elbow dislocation is defined as a dislocation that has remained unreduced for >2 weeks. The soft-tissue and skeletal changes that develop during this time usually prevent successful closed reduction. These changes include the development of extensive intra-articular fibrotic tissue, as well as contracture of the triceps, collateral ligaments, and elbow capsule. Ulnar nerve involvement and associated fractures may also be present. Because treatment of chronic elbow dislocation is challenging, a stepwise approach is used in the evaluation and management of this condition. No large series of data are available to guide treatment. Most patients are treated on the basis of the surgeon's anecdotal experience. Treatment typically involves open reduction, often with the use of hinged external fixators. The role of triceps lengthening or primary collateral ligament reconstruction remains a topic of debate.