Outcomes of elbow fracture-dislocations treated with and without an Internal Joint Stabilizer of the Elbow (IJS-E): A retrospective cohort study

Abstract

Background The internal joint stabilizer of the elbow (IJS-E) adds to techniques for maintaining reduction of elbow fracture-dislocations while allowing early motion. Literature on this device is limited to small case series. Methods Retrospective comparison of function, motion and complications in patients who sustained elbow fracture-dislocations reconstructed with (30 patients) and without (34 patients) an IJS-E by a single surgeon. The minimum follow up was 10 weeks. Results The mean follow up was 16 ± 17 months. The mean final flexion arc did not differ between the two groups, however patients without an IJS achieved greater pronation. There were no differences in mean Mayo Elbow Performance, Quick-DASH and pain scores. Five patients (17%) underwent IJS-E removal. The rates of capsular releases for stiffness after 12 weeks and recurrent instability were similar. Conclusions The use of an IJS-E to supplement traditional repair of elbow fracture-dislocations does not appear to affect final function or motion, and appears to be effective in reducing the risk of recurrent instability in a group of patients deemed high risk. However, its use is weighed against a 17% rate of removal at early follow up and possibly inferior forearm rotation. Level of Evidence Retrospective Cohort study, Level 3

The Internal Joint Stabilizer of the Elbow: A Systematic Review of the Clinical and Biomechanical Evidence

“…A total of nine retrospective reports on the IJS with a sample of 171 cases and a mean follow-up of 10.8 months were included ( Table 1 ). 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 The mean MCMS was 61 (range: 56–67), which indicates a moderate quality of reporting across all groups. Indications are detailed in Table 2 , and device-related complications are demonstrated in Table 3 .…”

“…The most common injury pattern for which the IJS was indicated was acute presentation of a terrible triad (53%). Across seven articles, the mean Disabilities of the Arm, Shoulder, and Hand score was 22.4 (range: 11.7–37), 10 , 11 , 12 , 13 , 14 , 15 , 17 and across four articles, the mean Mayo Elbow Performance Score (MEPS) was 82 (range: 74–94). 13 , 14 , 15 , 17 All nine articles reported the elbow flexion extension arc for a mean of 111°.…”

“…Across seven articles, the mean Disabilities of the Arm, Shoulder, and Hand score was 22.4 (range: 11.7–37), 10 , 11 , 12 , 13 , 14 , 15 , 17 and across four articles, the mean Mayo Elbow Performance Score (MEPS) was 82 (range: 74–94). 13 , 14 , 15 , 17 All nine articles reported the elbow flexion extension arc for a mean of 111°. The pooled rate of device failure was 4.4% (range: 0% to 12%) with four of the nine reports having zero cases of device failure.…”

“…Notably, three of the articles that reported a case of recurrent instability described this occurring in the presence of coronoid deficiency. 10 , 11 , 14 Sheth et al 14 remarked that cases with large coronoid fragments or coronoid deficiency may require more robust stabilization and alluded to their previous report on a medially placed IJS.…”

Revision management of a 17-year-old patient initially treated with radial head excision following terrible triad injury with associated Essex Lopresti

“…5 ). 29 , 32 The proximal radius was prepared for arthroplasty according to the previously described technique (Align; Skeletal Dynamics, Miami, FL, USA). 11 , 21 Prosthetic length was determined in relation to the corner formed by the lesser and greater sigmoid notch when evaluated on a true anteroposterior fluoroscopic image with the forearm in supination.…”