Strategies in Trauma and Limb Reconstruction

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VOLUME 4 , ISSUE 2 ( October, 2009 ) > List of Articles

Original Article

Treatment of chronically unreduced complex dislocations of the elbow

Roland Ivo, Konrad Mader, Jens Dargel, Dietmar Pennig

Keywords : Chronic elbow dislocation, Hinged external fixation, Elbow distraction, In situ neurolysis of ulnar nerve

Citation Information : Ivo R, Mader K, Dargel J, Pennig D. Treatment of chronically unreduced complex dislocations of the elbow. 2009; 4 (2):49-55.

DOI: 10.1007/s11751-009-0064-1

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2009; The Author(s).


Abstract

Chronic dislocation of the elbow is an exceedingly disabling condition associated with severe instability, limitation of elbow function and significant pain. Due to the potentially conflicting goals of restoring elbow stability and regaining a satisfactory arc of motion, successful treatment is a challenge for the experienced trauma surgeon. We report our treatment strategy in three patients suffering from chronically unreduced fracture-dislocations of the elbow. The treatment protocol consists of in situ neurolysis of the ulnar nerve, distraction and reduction of the joint using unilateral hinged external fixation and repair of the osseous stabilizers. A stable elbow was achieved in all patients, without the need of reconstruction of the collateral ligaments. At final follow-up, the average extension/flexion arc of motion was 107° (range, from 100° to 110°). The average MEPI score at follow-up was 93, and the average DASH score was 19. This is a promising treatment protocol for the treatment of chronically unreduced complex elbow dislocations to restore elbow stability and regain an excellent functional outcome.


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  1. Jupiter JB (1992) Trauma to the adult elbow fractures of the distal humerus. In: Browner BD, Levine AM, Trafton PG (eds) Skeletal trauma, vol 2. Saunders, Philadelphia, p 1141
  2. King GJW (2007) The complex dislocations of the elbow. In: Celli A, Celli L, Morrey BF (eds) Treatment of elbow lesions. Springer, Milan, p 103
  3. Kuhn MA, Ross G (2008) Acute elbow dislocations. Orthop Clin North Am 39:155-161
  4. DeLee JC, Green DP, Wilkins KE (1984) Fractures and dislocations of the elbow. In: Rockwood CA, Green DP (eds) Fractures in adults, 2nd edn. Lippincott, Philadelphia, p 559
  5. Linscheid RL, Wheeler DK (1965) Elbow dislocations. JAMA 194:113-118
  6. Endean ED, Veldenz HC, Schwarcz TH, Hyde GL (1992) Recognition of arterial injury in elbow dislocation. J Vasc Surg 16:402-406
  7. Jupiter JB, Ring D (2002) Treatment of unreduced elbow dislocations with hinged external fixation. J Bone Joint Surg Am 84-A:1630-1635
  8. Regan W, Morrey BF (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71:1348-1354
  9. Mader K, Koslowsky TC, Gausepohl T, Pennig D (2007) Mechanical distraction for the treatment of posttraumatic stiffness of the elbow in children and adolescents. Surgical technique. J Bone Joint Surg Am 89(Suppl 2):26-35
  10. Mader K, Pennig D, Gausepohl T, Koslowsky TC, Wulke AP (2004) Post-traumatic stiffness of the elbow: arthodiatasis using unilateral hinged external fixation. Scientific exhibit at the 71st AAOS meeting, San Francisco, California, March 10-14
  11. Pennig D, Gausepohl T, Mader K (2000) Transarticular fixation with the capacity for motion in fracture dislocations of the elbow. Injury 31(Suppl 1):35-44
  12. O‘Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113-136
  13. Terada N, Yamada H, Seki T, Urabe T, Takayama S (2000) The importance of reducing small fractures o the coronoid process in treatment of unstable elbow dislocation. J Shoulder Elbow Surg 9:344-346
  14. Morrey BF, Adams RA (1992) Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 74:479-490
  15. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand). The Upper Extremity Collaborative Group. Am J Ind Med 29:602-608
  16. Lyons RP, Armstrong A (2008) Chronically unreduced elbow dislocations. Hand Clin 24:91-103
  17. Ruch DS, Triepel CR (2001) Hinged elbow fixation for recurrent instability following fracture dislocation. Injury 32(Suppl 4):70-78
  18. Degreef I, De Smet L (2007) Chronic elbow dislocation: a rare complication of tennis elbow surgery. Successful treatment by open reduction and external fixator. Chir Main 26:150-153
  19. Lo CY, Chang YP (2004) Neglected elbow dislocation in a young man: treatment by open reduction and elbow fixator. J Shoulder Elbow Surg 13:101
  20. Ohno Y, Shimizu K, Ohnishi K (2005) Surgically treated chronic unreduced medial dislocation of the elbow in a 70-year-old man: a case report. J Shoulder Elbow Surg 14:549-553
  21. Ring D, Hannouche D, Jupiter JB (2004) Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. J Hand Surg 29A:470-480
  22. Sunderamoorthy D, Smith A, Woods DA (2005) Recurrent elbow dislocation—an uncommon presentation. Emerg Med J 22:667-669
  23. Balchandani RH (1969) Unreduced dislocations of the elbow. Proceedings of the Indian Orthopaedic Association. J Bone Joint Surg Br 51:781
  24. Ashby ME (1974) Old dislocations of the elbow. J Natl Med Assoc 66:465-467, 471
  25. Krishnamoorthy S, Bose K, Wong KP (1976) Treatment of old unreduced dislocation of the elbow. Injury 8:39-42
  26. Billett DM (1979) Unreduced posterior dislocation of the elbow. J Trauma 19:186-188
  27. Dryer RF, Buckwalter JA, Sprague BL (1980) Treatment of chronic elbow instability. Clin Orthop 148:254
  28. Naidoo KS (1982) Unreduced posterior dislocations of the elbow. J Bone Joint Surg Br 64:603-606
  29. Fowles JV, Kassab MT, Douik M (1984) Untreated posterior dislocation of the elbow in children. J Bone Joint Surg Am 66:921-926
  30. Martini M, Benselama R, Daoud A (1984) Neglected luxations of the elbow. 25 surgical reductions. Rev Chir Orthop Reparatrice Appar Mot 70:305-312 (French)
  31. Arafiles RP (1987) Neglected posterior dislocation of the elbow. A reconstruction operation. J Bone Joint Surg Br 69:199-202
  32. di Schino M, Breda Y, Grimaldi FM, Lorthioir JM, Merrien Y (1990) Surgical treatment of neglected elbow dislocations. Report of 81 cases. Rev Chir Orthop Reparatrice Appar Mot 76:303-310 (French)
  33. Bruce C, Laing P, Dorgan J, Klenerman L (1993) Unreduced dislocation of the elbow: case report and review of the literature. J Trauma 35:962-965
  34. Moritomo H, Tada K, Yoshida T, Kawatsu N (1998) Reconstruction of the coronoid for chronic dislocation of the elbow. J Bone Joint Surg Br 80:490-492
  35. Devnani AS (2004) Outcome of longstanding dislocated elbows treated by open reducation and excision of collateral ligaments. Singapore Med J 45:14-19
  36. Mahaisavariya B, Laupattarakasem W (2005) Neglected dislocation of the elbow. Clin Orthop Rel Res 431:21
  37. Mighell MA, Dunham RC, Rommel EA, Frankle MA (2005) Primary semi-constrained arthroplasty for chronic fracturedislocations of the elbow. J Bone Joint Surg Br 87:191-195
  38. Majima M, Horii E, Nakamura R (2007) Treatment of chronic dislocated elbows: a report of three cases. J Shoulder Elbow Surg 16:e1-e4
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