EARLY OPERATIVE TREATMENT OF UNSTABLE ELBOW DISLOCATIONS WITH OPEN STABILIZATION AND IMMEDIATE MOBILIZATION

Abstract

Purpose: A prospective study of early operative treatment of unstable elbow dislocations using a surgical algorithm.

Methods: We present the early results of nine such injuries including five terrible triads of the elbow and four elbows which redislocated in plaster. The avulsed lateral collateral ligament complex was reattached using a bone anchor in all cases. Coronoid and radial head fractures were fixed. In the four redislocations, full stability was only restored when the medial collateral ligament was reattached. Mobilization without a hinged fixator was allowed from day one. Patients were assessed for stability, ROM, and functional disability using the DASH score at an average of 13 months.

Results: No elbows redislocated post-operatively and no patients complained of instability. Mean extension was 18° (95% CI 7° – 28°), flexion 131° (124° – 137°), pro-nation 76° (56° – 96°), supination 82° (75° – 90°). Mean DASH score was 11.0 (95% CI 3.5 – 18.6).

Conclusion: Early reconstruction of unstable elbow dislocations, including the terrible triad, prevents the poor results which are commonly found following non-operative treatment of such injuries. An external fixator is not usually required in the acute setting.