Hinged external fixation for complex fracture-dislocation of the elbow in elderly people

Maniscalco, Pietro; Pizzoli, Andrea; Brivio, L. Renzi; Caforio, Marco

doi:10.1016/j.injury.2014.10.024

Cited by 28 publications

(8 citation statements)

References 13 publications

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“…Prolonged bracing or even fixation with a temporary external fixation may be required to protect the repaired structure, which can result in joint stiffness. 15 …”

Section: Discussionmentioning

confidence: 99%

Using an Internal Joint Stabilizer Through a Single Posterior Approach for Elderly Patients With Terrible Triad Injury

Chiu

Tsai

et al. 2023

Geriatr Orthop Surg Rehabil

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Introduction Treating a terrible triad injury of the elbow remains a challenge for orthopedic surgeons, especially in elderly patients due to the poor quality of the surrounding soft tissue and bony structures. In the present study, we propose a treatment protocol using an internal joint stabilizer through a single posterior approach and analyze the clinical results. Materials and Methods We retrospectively reviewed 15 elderly patients with terrible triad injuries of the elbow who underwent our treatment protocol from January 2015 to December 2020. The surgery involved a posterior approach, identification of the ulnar nerve, bone and ligament reconstruction, and the application of the internal joint stabilizer. A rehabilitation program was initiated immediately after the operation. Surgery-related complications, elbow range of motion (ROM), and functional outcomes were evaluated. Results The mean follow-up period was 21.7 months (range, 16-36 months). ROM at the final follow-up was 130° in extension to flexion and 164° in pronation to supination. The mean Mayo Elbow Performance Score was 94 at the final follow-up. Major complications included breaking of the internal joint stabilizer in 2 patients, transient numbness over the ulnar nerve territory in one, and local infection due to irritation of the internal joint stabilizer in one. Conclusions Although the current study involved only a small number of patients and the protocol comprised two stages of operation, we believe that such a technique may be a valuable alternative for the treatment of these difficult cases. Level of Clinical Evidence 4.

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“…Prolonged bracing or even fixation with a temporary external fixation may be required to protect the repaired structure, which can result in joint stiffness. 15 …”

Section: Discussionmentioning

confidence: 99%

Using an Internal Joint Stabilizer Through a Single Posterior Approach for Elderly Patients With Terrible Triad Injury

Chiu

Tsai

et al. 2023

Geriatr Orthop Surg Rehabil

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“…Simple realignment of the metaphyseal fragments utilizing the fixator, if properly applied, can neutralise all the dislocating forces around the elbow. 16 Hinged elbow fixators have been used in cases where residual instability is seen after ligament repair or fracture reduction. 11 , 17…”

Section: Discussionmentioning

confidence: 99%

Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results

Eygendaal¹,

Mader²,

Rollo³

et al. 2022

Strategies in Trauma and Limb Reconstruction

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A bstract 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. How to cite this article Meccariello L, Caiaffa V, Mader K, et al . Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results. Strategies Trauma Limb Reconstr 2022;17(2):68–73.

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“…The stress transmitted between nails stimulates the regeneration and reconstruction of bone tissue [8]. Previous studies have justi ed the bene ts of an external xator in the treatment of fractures, as it can (1) maintain fracture stability by resisting rotation, shearing and varus-valgus forces [9,10]; (2) alleviate articular surface stress for articular fractures, thus protecting the articular surface [11]; and (3) supply a suitable environment for soft tissue and muscle recovery [12]. At present, external xators are rarely used in trauma scenes, especially in eld medical treatment.…”

Section: Discussionmentioning

confidence: 99%

A Novel External Fixator to Facilitate Accurate and Efficient Fracture Treatment

Shen¹,

Wang²,

Ai³

et al. 2021

Preprint

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Background: The rapid popularization and application of bone external fixation technology has led to external fixators emerging as remarkable methods to treat various complex fractures. Because of their instability, assembly complexity and poor controllability, however, new external fixators are challenging to design in terms of facilitating accurate and efficient fracture treatment.Methods: We designed a novel external fixator that could feasibly treat clinical complex fractures. A prospective study was conducted on patients with various complex fractures from September 2017 to September 2019. During this period, we treated 24 patients with a universal joint external fixator and then evaluated its therapeutic effects. In this study, adult cadaver femur fracture fixations were modelled by using universal joint (UJ) and AO external fixators, and the mechanical stability was assessed by applying a biomechanical testing device.Results: The designed device not only fits the repair site but could also be conveniently installed and implanted. All patients achieved good fixation and fracture healing with the universal joint fracture external fixators. In in vitro biomechanical testing, constructs were loaded under axial compression, lateral compression and torsion. Overall axial stiffness showed no significant differences between the two groups. The lateral stiffness was 1.554 ± 0.017 mm for the UJ group and 1.342 ± 0.020 mm for the AO group (p<0.001) under a 600 N load, while the torsional stiffness was 15.727 ± 0.141° for the UJ group and 14.472 ± 0.292° for the AO group under a 40 Nm load.Conclusion: In this small and preliminary study, the universal joint external fixator, which achieved a stable mechanical structure, was capable of intensive and efficient treatment for comprehensive fractures. If these findings can be confirmed in a larger study, this external fixator may be widely used in certain situations where traditional external fixators are not a convenient option.

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Hinged external fixation for complex fracture-dislocation of the elbow in elderly people

Cited by 28 publications

References 13 publications

Using an Internal Joint Stabilizer Through a Single Posterior Approach for Elderly Patients With Terrible Triad Injury

Using an Internal Joint Stabilizer Through a Single Posterior Approach for Elderly Patients With Terrible Triad Injury

Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results

A Novel External Fixator to Facilitate Accurate and Efficient Fracture Treatment

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