Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Abstract

Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

Conservative Versus Surgical Management of Elbow Medial Ulnar Collateral Ligament Injury: A Systematic Review

“…The main value of the Downs and Black scale was 11.1 points, showing that the mean quality of included studies was poor. In fact, among the 15 studies considered, 12 had poor results and 3 had fair results (5 papers had 9 points, 5 papers had 12 points, 1 paper had 13 points, 1 paper had 14 points, and 3 papers had 15 points).…”

“…The elbow involved in the MUCL lesion was specified in only 5 studies: the dominant side was involved in 302 (97.4%) of 310 elbows, while the non‐dominant side was involved in 8 (2.6%) elbows. The type of injury was described in all studies except for 1 study: sport‐related and accidental trauma‐related MUCL injuries (usually not isolated lesions) were the two main causes. The types of lesion are detailed in Table .…”

“…The types of lesion are detailed in Table . Patients were assessed at an average follow‐up period of 32.6 months, ranging from 12 to 60 months . After dividing the patients into three groups according to the different therapeutic treatment: 81 patients had a conservative treatment (C‐group), 269 patients had surgical treatment only (S‐group), and 163 patients underwent surgery after a failed conservative treatment (C&S‐group).…”

“…For the selected studies, different conservative approaches and surgical treatments were analyzed (Table ). The first treatments were: hinged external fixator, conservative treatment after closed reduction and short‐term immobilization, PRP injection, and physical therapy. The second treatments were mainly represented (13/15 studies) by ligament open repair procedures, performed using different techniques.…”

CORR Insights®: Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

“…A protective external fixator offers a reasonable option to support this goal. Iordens and colleagues [3] use an image intensifier to determine the position of the guide pin in turn setting the center of rotation for the hinged fixator-a time-honored technique. The fixator pins are inserted under direct vision through 4 cm incisions to avoid nerve damage.…”