Citation Information :
Meccariello L, Caiaffa V, Mader K, Prkic A, Eygendaal D, Bisaccia M, Pica G, Utrilla-Hernando S, Pica R, Rollo G. Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. 2022; 17 (2):68-73.
Introduction: Injuries around the elbow pose a challenging problem for orthopaedic surgeons. The complex bony architecture of the joint should be restored and the thin soft tissue envelope needs to be handled with meticulous care. Elbow instability is a complication seen after dislocations and fractures of the elbow and remains a treatment challenge. The purpose of this study was to provide subjective and objective results following the surgical treatment of unstable elbow dislocations with an external hinged fixation technique.
Methods: Forty-six consecutive patients with complex trauma of the elbow with instability after ligament reconstruction were enrolled between January 2017 and December 2019. The parameters used to quantify the subjective and objective functional results were the Mayo Elbow Score (MES, objective) and Oxford Elbow Score (OES, subjective), and clinical stability of the elbow joint. We also performed a radiological follow-up of the fractures.
Results: The mean MES and OES scores were good at the 12-month follow-up. We had 38 patients with stable joints and 8 patients with minor instability. Using the stress test, we saw a significant difference in the affected joint under varus stress (6.7 ± 1.8 mm) compared to the healthy joint (5.8 ± 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (5.8 ± 0.8 mm, treated elbow) than the contralateral gap under valgus stress (4.3 ± 0.8 mm) (p <0.001). Twenty-one complications occurred in 46 patients (46%): Seven patients had a clinical change of elbow axis: Three valgus (6%), four varus (9%); Superficial wound infection occurred in one case (2%) and ulnar nerve dysfunction in two (4%). The most common medium-term complication was post-traumatic osteoarthritis in eight cases (17%). Heterotopic ossification occurred in five patients (11%) and elbow stiffness in five cases (11%).
Conclusion: The use of the hinged elbow external fixator in the treatment of complex elbow trauma is a valid therapeutic adjunct to ligamentous reconstruction showing encouraging results with acceptable complications.
Stavlas P, Gliatis J, Polyzois V, et al. Unilateral hinged external fixator of the elbow in complex elbow injuries. Injury 2004;35(11):1158–1166. DOI: 10.1016/j.injury.2003.09.002.
Lerner A, Stein H, Calif E. Unilateral hinged external fixation frame for elbow compression arthrodesis: the stepwise attainment of a stable 90-degree flexion position: a case report. J Orthop Trauma 2005;19(1):52–55. DOI: 10.1097/00005131-200501000-00010.
Ahmed I, Mistry J. The management of acute and chronic elbow instability. Orthop Clin North Am 2015;46(2):271–280. DOI: 10.1016/j.ocl.2014.11.008.
Feranec M, Hart R, Kozák T. Hinged external fixation in orthopaedic and trauma surgery of the elbow. Acta Chir Orthop Traumatol Cech 2013;80(6):391–395. PMID: 24750966.
Wyrick JD, Dailey SK, Gunzenhaeuser JM, et al. Management of complex elbow dislocations: a mechanistic approach. J Am Acad Orthop Surg 2015;23(5):297–306. DOI: 10.5435/JAAOS-D-14-00023.
Ebrahimzadeh MH, Amadzadeh-Chabock H, Ring D. Traumatic elbow instability. J Hand Surg Am 2010;35(7):1220–1225. DOI: 10.1016/j.jhsa.2010.05.002.
Tarassoli P, McCann P, Amirfeyz R. Complex instability of the elbow. Injury 2017;48(3):568–577. DOI: 10.1016/j.injury.2013.09.032.
Rollo G, Meccariello L, Rotini R, et al. Efficacy of the “Salento technique”, a modified two-incision approach in distal biceps brachii tendon repair. Surgical description and outcomes analysis. J Clin Orthop Trauma 2019;10(5):959–964. DOI: 10.1016/j.jcot.2019.02.006.
Calori GM, Colombo M, Mazza EL, et al. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury 2014;45 (Suppl 6):S93–S97. DOI: 10.1016/j.injury.2014.10.030.
Rollo G, Rotini R, Eygendaal D, et al. Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures. J Shoulder Elbow Surg 2018;27(7):1326–1332. DOI: 10.1016/j.jse.2018.02.073.
Hopf JC, Berger V, Krieglstein CF, et al. Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results. J Shoulder Elbow Surg 2015;24(2):250–257. DOI: 10.1016/j.jse.2014.09.034.
Whelan DB, Bhandari M, Stephen D, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 2010;68(3):629–632. DOI: 10.1097/TA.0b013e3181a7c16d.
Sakai K, Shirahama M, Shiba N, et al. Primary hinged external fixation of terrible triad injuries and olecranon fracture-dislocations of the elbow. Kurume Med J 2016;63(1.2):7–14. DOI: 10.2739/kurumemedj.MS6300003.
Yu S, Wang W, Liu S, et al. Arthrolysis and delayed internal fixation combined with hinged external fixation for elbow stiffness associated with malunion or nonunion of capitellum fracture. J Shoulder Elbow Surg 2015;24(6):941–946. DOI: 10.1016/j.jse.2015.01.019.
Castelli A, D'amico S, Combi A, et al. Hinged external fixation for Regan–Morrey type I and II fractures and fracture-dislocations. J Orthopaed Traumatol 2016;17(2):175–179. DOI: 10.1007/s10195-016-0395-x.
Maniscalco P, Pizzoli AL, Brivio LR, et al. Hinged external fixation for complex fracture-dislocation of the elbow in elderly people. Injury 2014;45:S53–S57. DOI: 10.1016/j.injury.2014.10.024.
Donohue KW, Mehlhoff TL. Chronic elbow dislocation: evaluation and management. J Am Acad Orthop Surg 2016;24(7):413–423. DOI: 10.5435/JAAOS-D-14-00460.