Abstract
Introduction Complex fracture dislocation of the elbow can often be either irreducible or unstable with inability to hold the reduction or delayed subluxation or dislocation. This study looks at the aetiology of the instability, bony and ligamentous, and the results following stabilisation with a combination of internal fixation, ligament repair, radial head arthroplasty and or hinged external fixation.
Methods Twenty-one consecutive unstable elbows referred to three tertiary centres were prospectively recruited for this study. All cases had fine-cut CT scans with sagittal, coronal and 3D reconstructions. All elbows were approached using a posterior ‘global’ incision. Ulnar neurolysis was routinely performed. Medial and lateral ligament complexes were inspected and repaired. Internal fixation of the radial head was attempted where indicated, or a radial head arthroplasty was performed. The coronoid-brachialis complex was repaired using pull-through sutures. Elbow stability was tested and a hinged external fixator used where indicated. The fixator was removed at six weeks. Indomethacin prophylaxis against heterotopic ossification was used routinely. Follow-up range of motion, articular congruity and DASH score were assessed at one year. All cases required a repair of the coronoid-brachialis complex. Radial head reconstruction was attempted in four cases, but abandoned in three. The radial head was replaced in 13 cases. A lateral repair alone was required in 12 cases, a medial repair alone in two cases and a combined medial and lateral repair in seven cases. Eighteen cases required a hinged device (nine Compass hinges and nine OpteROM distractors).
Results The mean less of extension at one year was 12° (range 0 to 20) and the mean loss of flexion was 14° (range 0 to 20). All cases achieved at least a functional arc of motion from 30° to 130°. Three cases achieved a full range of motion. Despite Indomethacin prophylaxis three cases developed minor heterotopic ossification. The average DASH score was 23.
Conclusions If managed appropriately, a very good anatomical and functional outcome can be achieved in difficult unstable elbows post fracture dislocation. Repair of the coronoid-brachialis complex is the key to stability, along with radial head reconstruction or replacement. A hinged external fixation device allows early mobilisation.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
