Acute severe valgus instability without elbow dislocation

Cho, Chul-Hyun; Bae, Ki-Cheor; Ye, Hee-Uk; Lee, Sung-Moon

doi:10.1016/j.jse.2015.04.009

Cited by 6 publications

(10 citation statements)

References 18 publications

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“…The pathoanatomy and treatment maneuvers of chronic valgus instability of the elbow due to iterative microtrauma following overhead throwing activities have been well researched [23–27]. Nevertheless, acute valgus instability of the elbow sustains a different traumatic mechanism and so leads to a different pathoanatomy [10]. Schwab et al [28] hypothesized the reasons why MCL tears often occur at the same time as the radial head fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Richard et al [14] reported complete avulsion of the MCL from its humeral footprint and disruption of the FPT leading to acute traumatic valgus instability in 11 collegiate athletes. Cho et al [10] reported 7 patients with acute gross valgus instability without elbow dislocation suffered from complete disruption of the MCL and FPT, with variable degrees of tears of the anterior capsule and bone contusion of the radial head and capitellum. Those authors believed that acute valgus instability is probably the initial phase of posterolateral dislocation of the elbow [10].…”

Section: Discussionmentioning

confidence: 99%

“…Cho et al [10] reported 7 patients with acute gross valgus instability without elbow dislocation suffered from complete disruption of the MCL and FPT, with variable degrees of tears of the anterior capsule and bone contusion of the radial head and capitellum. Those authors believed that acute valgus instability is probably the initial phase of posterolateral dislocation of the elbow [10]. Davidson et al [15] reported varying degrees of acute valgus instability of the elbow due to avulsion of the MCL in 22 of 50 cases of radial head fractures.…”

Section: Discussionmentioning

confidence: 99%

“…The medial collateral ligament (MCL), specifically the anterior bundle of MCL (AMCL), functions as the primary static stabilizer to valgus stress, versus the radial head functions as the secondary static stabilizer [1, 5]. Lately, the importance of the flexor-pronator tendon (FPT) in maintaining valgus stability has attracted more and more attention [6–10]. Although the function of the FPT is not yet explicit, it may be a vital dynamic constraint to valgus stress, and its disruption can aggravate valgus instability of the elbow.…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology, clinical features, and treatment of valgus instability resulting from ligamentous injuries in dislocation of the elbow have been well studied [7, 11, 12]. A few studies have also reported on acute valgus instability resulting from tears of medial stabilizers without elbow dislocation [10, 13, 14]. Severe traumatic valgus instability may be associated with the rupture of the MCL and lesions of the radiocapitellar articulation.…”

Section: Introductionmentioning

confidence: 99%

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Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Zhang

Wang

et al. 2019

J Orthop Surg Res

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BackgroundThe objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation.MethodsThirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe median follow-up was 37.3 months (range, 15–53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up.ConclusionsRadial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Zhang

Wang

et al. 2019

J Orthop Surg Res

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Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Schnetzke

Ellwein

Maier

et al. 2020

Arch Orthop Trauma Surg

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Introduction The aim of the present study was to analyze the injury pattern and thus the dislocation mechanism after simple elbow dislocation using radiographs and magnetic resonance imaging (MRI) data sets. Materials and methods The MRI data sets of 64 patients with a mean age of 44 years (18-77 years) were analyzed retrospectively. The inclusion criteria for the study were (1) radiograph with confirmed simple elbow dislocation, (2) low-energy trauma, (3) MRI of the affected elbow ≤ 3 weeks after trauma. The dislocation direction was determined using radiographs. The integrity of the lateral collateral ligament complex (LCLC), common extensor origin (CEO), anterior capsule (AC), medial collateral ligament (MCL), and common flexor origin (CFO) as well as the joint congruity were assessed based on MRI. Results 34 patients (53%) had a posterolateral, 26 patients (41%) a posterior, and 4 patients (6%) a posteromedial dislocation. LCLC and AC were affected in 64 out of 64 patients (100%). MCL was affected in 58 patients (91%). CEO were affected in 25 patients (39%) and the CFO in 20 patients (31%). In 11 patients (17%) the injury pattern was more pronounced medially than laterally (MCL, CFO, LCLC), with 2 of these patients exhibiting only a partial LCLC tear. All cases with joint incongruency (n = 12, 19%) showed CEO and/or CFO involvement. Conclusions Simple elbow dislocation leads to a very heterogeneous spectrum of soft tissue injury pattern. A small proportion of patients showed medially pronounced injury patterns. These findings strongly indicate existence of a "reversed Horii circle" with an underlying valgus mechanism (medial force induction) originating and continuing from medial to anterior.

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Analysis of Fracture Characteristic and Medial Collateral Ligament Injury Relationships in Terrible Triad Elbow Injuries

Jung

Lee

Kim

et al. 2021

The Journal of Hand Surgery

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Acute severe valgus instability without elbow dislocation

Cited by 6 publications

References 18 publications

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Analysis of Fracture Characteristic and Medial Collateral Ligament Injury Relationships in Terrible Triad Elbow Injuries

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