Chronic Elbow Dislocation Research Articles

Outcomes after surgical stabilization of chronic traumatic elbow dislocations

Background: Several surgical protocols have been described for reduction and stabilization of chronic, posttraumatic elbow dislocations. These are supported by small case series only, and treatment recommendations remain inconclusive. Our purpose was to evaluate the outcomes of surgical treatment in a series of chronic, posttraumatic elbow dislocations at our institution. Methods: We retrospectively reviewed the charts of all patients with chronic elbow dislocations treated with a stabilization procedure. We identified 10 patients (average dislocation duration 39.6 wk) with an average follow-up at our institution of 26 mo (4 to 55 mo). Results: Five women and five men with prior elbow dislocations (two simple, eight complex; five terrible triad, three Monteggia, two Essex-Lopresti) were included. Six patients had undergone one or more unsuccessful stabilization procedures at an outside hospital. At our institution, the patients were treated with a surgical stabilization protocol tailored to their injury. At final follow-up, eight patients had a stable, concentrically reduced elbow and regained a painless, functional arc of motion. Two patients with type III coronoid fractures that could not be reconstructed had recurrent dislocations. Six patients required medial collateral ligament reconstruction to maintain stability, suggesting that medial collateral ligament injury contributed to persistent elbow instability. Conclusions: In our series, a stable and painless elbow with a functional arc of motion was restored in eight of 10 patients with chronic elbow dislocations. The presence of a type III coronoid fracture increased the risk of failure. Level of Evidence: Level IV, Case Series.

Chronic Unreduced Elbow Dislocation Treated with Hinged External Fixator and Transarticular Pin Fixation

Chronic Unreduced Elbow Dislocation Treated with Hinged External Fixator and Transarticular Pin Fixation

Complications Associated With Hinged External Fixation for Chronic Elbow Dislocations

To evaluate the outcomes of patients who underwent application of hinged external fixators for chronic elbow fracture-dislocations. We hypothesized that patients treated for this injury pattern can achieve satisfactory outcomes but encounter many complications and require numerous additional procedures. We performed a retrospective review of 7 patients who were surgically treated with application of a hinged external fixator for chronic ulnohumeral elbow fracture-dislocation. Patients were included only if they had complete ulnohumeral dislocation of greater than 1month's duration. Demographics, injury pattern, and range of motion were documented. Preoperative and postoperative range of motion was recorded and any treatment complications or additional surgeries were noted. The interval between the initial injury and index procedure averaged 8 months. All patients underwent initial treatment with open reduction internal fixation. Average arc of ulnohumeral motion improved from 26° (range, 0° to 60°) to 120° (range, 100° to 145°). Overall, 4 of 7 patients developed at least one complication during treatment. Three patients required additional procedures aside from removal of the hinged external fixator. These 3patients underwent a total of 13 additional procedures. Although patients can achieve good outcomes, realistic expectations should be set. Patients should be aware that surgery can be associated with a high risk of complications, potential treatment failure, and a need for additional surgical procedures. Therapeutic IV.

Reconstruction of deficient coronoid for treatment of chronic elbow dislocation

Objective To report clinical results of reconstruction of the deficient coronoid to improve the elbow stability for the treatment of chronic elbow dislocation. Methods From July 2008 to January 2010, we preformed coronoid reconstruction with autogenous olecranon or radial head after arthrolysis for 6 patients with chronic elbow dislocation complicated with deficient coronoid. All the 6 patients were male, withan average age of 30.5 years (18 to 42 years) at the time of surgery. Four right and 2 left elbows were affected. The average time from injury to surgery was 5 months (2 to 11 months) . All the primary injuries were terrible triad. The average range of elbow motion before operation was 13.3° (0 to 35°), and the average range of forearm rotation before operation was 62.5° (10° to 140°) . Through a standard posterior skin inci sion, the elbow joint was dislocated posteriorly in extension after arthrolysis to reconstruct the coronoid with autogenous olecranon or radial head. After fixation with screws or k-wires, the Stryker hinged external fixator was used for protection. Exercise began the first day after operation, Indomethacin was administered to prevent ectopic ossification. The external fixator was removed after 8 weeks. Results The mean follow-up time was 12 months (3 to 21 months) . The average range of elbow motion after operation was 120.0° ( 100° to 140°), and the average range of forearm rotation after operation was 141.7° (110°to 170°) . The average Mayo elbow performance score increased from 51.7 (50 to 55) before operation to 97.5 (85 to 100) after operation. All the 6 elbows were stable in extension after coronoid reconstruction. Conclusion Since coronoid reconstruction with autogenous olecranon or radial head can substantially improve the elbow stability,it is a good treatment for chronic elbow dislocation complicated with deficient coronoid. Key words: Elbow joints; Dislocation; Wounds and injuries; Recovery of function

Guidelines for managing posterior elbow dislocations: Lessons to be learnt

A 62-year-old lady fell onto her out-stretched rightarm and presented to accident and emergency witha posterior dislocation of her right elbow and anundisplaced radial head fracture. The dislocationwas reduced and an above elbow back-slab applied.Post-manipulationradiographsconfirmed asatisfac-tory reduction. She represented to accident andemergency 2 days later with increased pain in herright elbow and the sensation that her elbow hadmoved. No X-ray was requested and the back-slabwas changed to a wool and crepe bandage.One week later, at fracture clinic, the lady wasexaminedandnotedtohaveapainful bruisedelbowwith a limited range of motion (flexion 30—908 andsupination and pronation to 458). No X-ray wasperformed and the lady was advised to start gentleelbow mobilisation. Two weeks later the symptomsand findings remained unchanged. Again, no radio-graphs were requested and the patient was dis-charged to physiotherapy.Thepatientwasre-referred3monthslater,totheseniorauthor,withanarcofmovementof308andnoimprovement in the range of movement. At thistime, examination revealed an incongruent elbowand X-rays confirmed a chronic posterior elbowdislocation and heterotropic ossification (Fig. 1).The lady then underwent elective open reductionusing a posterior, triceps elevating approach, exci-sionoftheheterotropicboneanddistractionarthro-lysis using the Stryker Dynamic Joint Distracter(Fig. 2).Immediate post-operative mobilisation of theelbow was commenced and the external fixator

Chronic dislocation of elbow

Chronic dislocation of elbow