Nonacute Treatment of Elbow Fracture with Persistent Ulnohumeral Dislocation or Subluxation

Chen, Neal C.; Jupiter, Jesse B.; Steinmann, Scott P.; Ring, David

doi:10.2106/jbjs.m.00817

Cited by 12 publications

(10 citation statements)

References 70 publications

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“…These improvements may be attributable to two major steps in our standardized protocol: the management of radial head and the LCL complex. Both of these tremendously impact radiocapitellar contact, which plays an important role in elbow stability [4, 26]. Based on study findings, surgeons may achieve a better outcome with functional motion using LCL reattachment instead of using complicated ligament reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of posttraumatic arthritis did not affect postoperative pain, disability, function, and ROM. The causes of unsatisfactory outcomes in complex persistent elbow instability are multifactorial, and several nonavoidable risk factors have been identified, such as the time from injury to treatment and severity of articular damage [4,20,31]. Sørensen and Søjbjerg [31] found that patients treated within 6 weeks of the initial injury had better MEPS.…”

Section: Effect Of Posttraumatic Arthritis On Pain and Functionmentioning

confidence: 99%

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Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?

Hsueh

et al. 2022

Clin Orthop Relat Res

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Background The treatment of complex persistent elbow instability after trauma is challenging. Previous studies on treatments have reported varied surgical techniques, which makes it difficult to establish a therapeutic algorithm. Furthermore, the surgical procedures may not sufficiently restore elbow stability, even with an additional device, and a noted high rate of arthritis progression.While a recently developed internal joint stabilizer effectively treats elbow instability, its clinical application for complex persistent elbow instability is limited and the standardized protocol is not well described. Additionally, we want to know whether the arthritis progression will cause a negative impact on the functional outcomes of complex persistent elbow instability. Questions/purposes (1) Does treatment of complex persistent elbow instability with a hinged internal joint stabilizer and a standardized protocol prevent recurrent instability and other complications? (2) What are the pre-to postoperative improvements in pain, disability, elbow performance, and ROM? (3) Is the development of posttraumatic arthritis associated with worse pain, disability, elbow performance, and ROM? Methods Between September 2014 and October 2019, we treated 22 patients for persistent dislocation or subluxation after initial treatment of traumatic elbow fracturedislocations. Of those, we considered patients who were at least 20 years of age, with an interval of 6 weeks or more between the injury (initial treatment) and the index reconstructive procedure, which had been performed at our institute, as potentially eligible. During that time, we used an internal joint stabilizer with a standardized protocol for posttraumatic complex persistent elbow instability. We performed total elbow replacements in patients older than 50 years who had advanced elbow arthritis. Based on that, 82% (18 of 22) of patients were eligible; 14% (3 of 22) were excluded because total elbow replacements was undertaken, and another 5% (1 of 22) were lost before the minimum study follow-up of 1 year (median 24 monthsThe study was funded by E-Da Hospital, Taiwan (EDAHP108035). Each author certifies that there are no outside funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Ethical approval for this study was obtained from (E-Da Hospital)

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Section: Discussionmentioning

confidence: 99%

Section: Effect Of Posttraumatic Arthritis On Pain and Functionmentioning

confidence: 99%

Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?

Hsueh

et al. 2022

Clin Orthop Relat Res

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“…Für die akuten, primären Bandrekonstruktionen wird ein enges Zeitfenster von 14 Tagen nach Trauma auf Grund einer progredienten Fibrose der verletzten kapsuloligamentären Strukturen angegeben [4,30]. Allerdings sind auch für verzögerte, augmentierte Bandrekonstruktionen unter der Voraussetzung eines ausreichend vorhandenen Restgewebes gute klinische Ergebnisse beschrieben (.…”

Section: Indikation Zur Operativen Stabilisierungunclassified

Sekundäre Bandrekonstruktion am Ellenbogen

Geßmann

Rausch

Königshausen

et al. 2017

Trauma Berufskrankh

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“…Following closed reduction most elbow dislocations are treated conservatively 3. Patients with a chronic elbow dislocation present for treatment later than 2 weeks from the initial injury 4. This patient group commonly necessitate open reduction and ligament reconstruction and may have a less favorable final outcome.…”

mentioning

confidence: 99%

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation

Sachinis

Vasiadis

Yiannakopoulos

et al. 2022

Techniques in Hand &Amp; Upper Extremity Surgery

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The task of achieving a good clinical outcome on patients with chronic elbow dislocation is arduous. Any stabilization method used should be robust enough in order to allow for early elbow motion. Immobilization of the elbow for a prolonged time period may lead to stiffness and heterotopic ossification. Several methods of ligament reconstruction have tried to address the global instability that is present in such scenarios. We describe a technique of reconstructing both bands of the medial ligament, and the lateral ulnar collateral ligament of the elbow, by using a looped tendon graft and reinforcing the lateral side with nonabsorbable tape and anchors. The graft is passed as a loop once through the humerus and ulna, recreating the anterior portion of the medial collateral ligament and the lateral ulnar collateral ligament. Then the lateral side is augmented with the tape and anchors and the loop is fixed. Lastly, the medial tail of the graft is used in order to recreate the posterior part of the medial ligament. This technique uses a single graft along with nonabsorbable tape and anchors to make a robust construct that will withstand early range of motion, without jeopardizing elbow stability. Potential complications include damage to the ulnar nerve, infection, elbow stiffness, or persistent instability in complex cases with bone involvement.

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Nonacute Treatment of Elbow Fracture with Persistent Ulnohumeral Dislocation or Subluxation

Cited by 12 publications

References 70 publications

Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?

Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?

Sekundäre Bandrekonstruktion am Ellenbogen

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation

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