Treatment of postero-lateral unstable elbow dislocation with/without fractures

Objectives Elbow dislocation fractures with postero-lateral instability are sometimes encountered, but successful treatment becomes often a challenge for the surgeon, due to the potentially conflicting goals of restoring elbow stability and regaining a satisfactory arc of motion. We report on twenty-four patients who suffered from postero-lateral unstable elbow dislocations with/without fractures.

Methods The average age of patients was 46.75 years (range, 17- 76 years). Nineteen patients were treated within two weeks after injury, and five were more than two weeks. All patients were treated with open reduction and internal fixation for the concomitant fractures, repair or/and reconstruction for the damaged soft tissue. The average follow-up period was 1.7 years (range from 3 months to 8 years). Sixteen cases showed complete dislocations, and four cases showed subluxations in the x-ray at their first visit. Seven cases had terrible triads, two had trans olecranon fractures, and six had concomitant other upper extremity fractures. Our surgical strategy is following; Anterior supporting structures (coronoid fracture and anterior capsule) were fixed and repaired at first, then radial head fracture was fixed or replaced to prosthesis, latter, the lateral collateral ligament complex and/or medial collateral ligament was repaired if necessary. Finally, if marked instability like irreducible dislocation was still remained, hinged external fixation or reconstruction of lateral ulnar collateral ligament (LUCL) was applied. Passive range of motion exercise was started after 3 days to 1 week postoperatively.

Results and Conclusion The average range of motion at follow-up was -12.2° (range; -30°- 0°) extension, 131.1° (range;

60°-145°) flexion. Clinical examination at follow-up revealed no evidence of elbow instability. Average Mayo Elbow Performance Score was 92.1 points (range; 60 -100 points). Only by a combination of open and anatomical reduction for bone and soft tissue components, mostly sable elbow was achieved for postero-lateral unstable elbow dislocations in 2/3 cases.

Our surgical strategy is useful for regaining sable elbow for postero-lateral unstable elbow dislocations. Further if severe instability remained intraoperatively, hinged external fixation or LUCL reconstruction might be helpful. More cases and longer-term assessment will be needed.

Stichwörter unstable elbow,dislocation fracture, postero-lateral instability

Publication History

Article published online:
15 October 2020