CONTRIBUTION OF EXTERNAL FIXATION FOR THE TREATMENT OF COMPLEX FRACTURE-DISLOCATION OF THE ELBOW

Abstract

Purpose of the study: Complex fracture-dislocation of the elbow, and subsequent surgical treatment, is often the source of a stiff joint. The purpose of this study was to assess the efficacy of a therapeutic protocol combining systematic insertion of a dynamic external fixator allowing early mobilization of the elbow with restitution of the radial height and the coronoid process.

Material and methods: This consecutive series of ten patient, six men and four women, mean age 49 years, age range 27–67 years, underwent surgery from 2002 to 2004. Three patients presented a posterior Monteggia fracture (two type IIA, one type IId associated with comminutive fracture of the trochlea), four patients presented a dislocation associated with a Masson 4 fracture of the radial head and two presented inveterated dislocations diagnosed three weeks after the traumatic event. In all, seven patients presented a fracture of the radial head and six a fracture of the coronoid process. For all patients, the operation consisted in stabilization with a dynamic external fixator of the elbow associated or not with restoration of the radial height with a radial head prosthesis (n=4) and reconstitution of the coronoid process (n=6). The lateral ligaments had to be reinserted in four elbows. The comminutive fracture of the rochlea was treated with an iliac crest graft.

Results: One patient died early. One patient presented pin tract infection and four developed heterotopic ossifications. At mean follow-up of twelve months, outcome was excellent in our patients, good in four, fair in one (Mayo clinic classification). All patients had a stable elbow. The mean range of motion was 89° flexion-extension and 145° pronationsupination.

Conclusion: In this series, systematic use of external fixation for complex fracture-dislocation of the elbow joint yielded satisfactory results when the element stabilizing the joint were appropriately restored and when rehabilitation was undertaken early.