The Journal of Bone and Joint Surgery (American) 86:1122-1130 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures
David M.W. Pugh, MD, FRCS(C)1,
Lisa M. Wild, BScN1,
Emil H. Schemitsch, MD, FRCS(C)1,
Graham J.W. King, MD, MSc, FRCS(C)2 and
Michael D. McKee, MD, FRCS(C)1
1 Upper Extremity Reconstructive Service, St. Michael's Hospital, 55 Queen
Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address for M.D.
McKee:
mckee{at}the-wire.com
2 University of Western Ontario, Hand and Upper Limb Centre, 268 Grosvenor
Street, London, ON N6A 4L6, Canada
Investigation performed at Upper Extremity Reconstructive Service, St.
Michael's Hospital, and University of Western Ontario, Hand and Upper Limb
Centre, London, Ontario, Canada
The authors did not receive grants or outside funding in support of their
research or preparation of this manuscript. They did not receive 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 elbow dislocations with associated radial
head and coronoid fractures are often poor because of recurrent instability
and stiffness from prolonged immobilization. We managed these injuries with a
standard surgical protocol, postulating that early intervention, stable
fixation, and repair would provide sufficient stability to allow motion at
seven to ten days postoperatively and enhance functional outcome.
Methods: We retrospectively reviewed the results of this treatment
performed, at two university-affiliated teaching hospitals, in thirty-six
consecutive patients (thirty-six elbows) with an elbow dislocation and an
associated fracture of both the radial head and the coronoid process. Our
surgical protocol included fixation or replacement of the radial head,
fixation of the coronoid fracture if possible, repair of associated capsular
and lateral ligamentous injuries, and in selected cases repair of the medial
collateral ligament and/or adjuvant hinged external fixation. Patients were
evaluated both radiographically and with a clinical examination at the time of
the latest follow-up.
Results: At a mean of thirty-four months postoperatively, the
flexion-extension arc of the elbow averaged 112° ± 11° and
forearm rotation averaged 136° ± 16°. The mean Mayo Elbow
Performance Score was 88 points (range, 45 to 100 points), which corresponded
to fifteen excellent results, thirteen good results, seven fair results, and
one poor result. Concentric stability was restored to thirty-four elbows.
Eight patients had complications requiring a reoperation: two had a
synostosis; one, recurrent instability; four, hardware removal and elbow
release; and one, a wound infection.
Conclusions: Use of our surgical protocol for elbow dislocations
with associated radial head and coronoid fractures restored sufficient elbow
stability to allow early motion postoperatively, enhancing the functional
outcome. We recommend early operative repair with a standard protocol for
these injuries.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.
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