Treatment of Unreduced Elbow Dislocation with Hinged External Fixation

Author(s): Jupiter JB, Ring D

Source: J Bone Joint Surg 84-A: 1630-1635, 2002

Summary:

This article provides a retrospective review of the treatment of five patients with a chronic elbow dislocation.  Three women and two men with an average age of forty-nine years (range, 30-59 years) were treated at an average of eleven weeks post-injury by the senior author between 1992 and 2000.  All patients were treated with a Compass Hinge Elbow Distractor with repair of the lateral soft-tissue envelope. No attempt was made to reconstruct the lateral or medial ligament structures.  The ulnar nerve was transposed anteriorly and no attempt was made to remove heterotopic ossification (HO) noted in 2 patients.  No HO prophylaxis was used.  The flexor-pronator muscle origin was always found to be intact on the medial elbow.  The hinge was removed at an average of 5 weeks post- treatment.  All patients maintained a concentric joint reduction.  There were two excellent and three good results using the Mayo Elbow Performance Index with an average of 89 points.  The average DASH score was 13 and the American Shoulder and Elbow Surgeons outcome instrument was 92 points.  Three patients reported mild pain, there was no residual instability and average motion ranged between 13 degrees of extension (range, 5 to 20 degrees) and 123 degrees of flexion (range, 120 to 140 degrees).  Four patients had radiographic evidence of mild joint-space narrowing and osteophyte formation.  One patient sustained a broken external fixation pin in the humerus and one patient experienced transient ulnar neuritis.

 

This article substantiates the treatment of chronic elbow dislocations with the use of a hinged external fixation device without formal ligament reconstruction.  All patients achieved a concentric joint reduction with a near functional arc of motion and minimal complications.  Chronic elbow dislocations associated with pure ligament injuries are quite rare and caution should be used in extrapolating this data to the more common chronic elbow fracture dislocations. 

 


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J Bone Joint Surg