The Journal of Bone and Joint Surgery (American) 84:1630-1635 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Treatment of Unreduced Elbow Dislocations with Hinged External Fixation
Jesse B. Jupiter, MD and
David Ring, MD
Investigation performed at Massachusetts General Hospital, Boston, Massachusetts
Jesse B. Jupiter, MD
David Ring, MD
Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 527, 15 Parkman Street, Boston, MA 02114. E-mail address for J.B. Jupiter: jjupiter1{at}partners.org E-mail address for D. Ring: dring@partners.org
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. Neither of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone.
Methods: Three women and two men (average age, forty-nine years) with an unreduced dislocation of the elbow without associated fractures were treated with open relocation of the joint and hinged external fixation at an average of eleven weeks (range, six to thirty weeks) after the initial injury. The lateral soft tissues, including the origin of the lateral collateral ligament complex, were reattached to the lateral epicondyle in three patients, but no attempt was made to reconstruct the ligaments, tendons, or bone. A passive worm gear incorporated into a hinged external fixator was used to mobilize the elbow initially, and active mobilization was gradually introduced. The hinge was removed at an average of five weeks after the procedure.
Results: At an average of thirty-eight months (range, twelve to ninety-eight months), a stable, concentric reduction had been maintained in all five patients, with radiographic signs of mild arthrosis in four. The average arc of flexion was 123x, and all patients had full forearm rotation. The average score on the Mayo Elbow Performance Index was 89 points, with two excellent and three good results. The average scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons outcome instruments (13 and 92 points, respectively) reflected mild residual pain and disability.
Conclusions: Treatment of unreduced elbow dislocations with open reduction and hinged external fixation as much as thirty weeks after the injury can restore a stable, mobile joint without the need for tendon-lengthening or transfer, ligament reconstruction, or deepening of the trochlear notch of the ulna.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
R. Z. Tashjian and J. A. Katarincic
Complex Elbow Instability
J. Am. Acad. Ortho. Surg.,
May 1, 2006;
14(5):
278 - 286.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Dowrick, B. J. Gabbe, O. D. Williamson, and P. A. Cameron
Does the disabilities of the arm, shoulder and hand (DASH) scoring system only measure disability due to injuries to the upper limb?
J Bone Joint Surg Br,
April 1, 2006;
88-B(4):
524 - 527.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Tan, A. Daluiski, J. Capo, and R. Hotchkiss
Hinged Elbow External Fixators: Indications and Uses
J. Am. Acad. Ortho. Surg.,
December 1, 2005;
13(8):
503 - 514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Mighell, R. C. Dunham, E. A. Rommel, and M. A. Frankle
Primary semi-constrained arthroplasty for chronic fracture-dislocations of the elbow
J Bone Joint Surg Br,
February 1, 2005;
87-B(2):
191 - 195.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Gartsman and S. S. Hasan
What's New in Shoulder and Elbow Surgery
J. Bone Joint Surg. Am.,
January 17, 2003;
85(1):
171 - 181.
[Full Text]
[PDF]
|
|
|
|
