This is a retrospective cohort of 17 patients from 2 institutions who were treated for a posterior dislocation of the elbow with no fracture, but with recurrent and persistent instability following reduction. The authors retrospectively evaluated the results of 17 patients with avulsion injuries of the lateral collateral complex and the anterior capsule that had persistent instability following reduction. Fifteen patients had open reduction and ligament repair, 8 had repair of the lateral complex alone, and 7 had repair of both the medial and lateral complex. In addition, 2 of these patients had application of an external fixator and 2 had immobilization in a cast for at least 1 month following the procedure.
The authors found that 5 of 17 patients (29%) had residual radiographic subluxation or dislocation following operative treatment. One had re-dislocation of the elbow and wound separation. One required irrigation and debridement, and application of an external fixator. Three patients developed heterotopic bone restricting motion. At the end of treatment, a concentric elbow joint was achieved in all 17 patients. The average flexion arc was 113 degrees, with an average flexion of 129 degrees and an average flexion contracture of 16 degrees. Categorical ranges indicated only 3 excellent, 10 good, and 2 fair. Four had radiographic evidence of arthrosis.
The significance of this article is that hinged external fixators (or temporary static frames) may be necessary in these highly unstable injuries, despite ligament reconstruction or repair. In addition, the authors found that splints or casts alone did not prevent re-dislocation in these highly unstable injuries. Ligament repair alone was associated with residual subluxation of 30%.