Primary Hinged External Fixation of Terrible Triad Injuries and Olecranon Fracture-Dislocations of the Elbow

Abstract

Summary:This study aimed to introduce a new treatment that apples primary hinged external fixation for complex fracture-dislocations of the elbow in 12 cases. We retrospectively assessed the functional outcomes of eight patients with terrible triad injuries and three patients with an olecranon fracture-dislocation of the elbow, who were treated at our hospital using a primary hinged external fixator between June 2012 and December 2014. Ten patients underwent repair or replacement of the radial head, while three underwent repair of the olecranon. In principle, they were treated without reconstruction of the coronoid fracture and collateral ligament injury. The patients were evaluated for a mean follow-up period of 16 months after the initial surgery. Early mobilization was encouraged while the hinged external fixator was in place. At the follow-up, the mean Mayo Elbow Performance Score was 93 points; the results were "excellent" in six cases and "good" in five. No patients had recurrent elbow instability. Only one patient needed an additional procedure after the initial operation. These results suggested that primary hinged external fixation without repair of the ligament and soft tissue is an effective minimally invasive surgery for the management of terrible triad injuries and olecranon fracture-dislocations of the elbow.

Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator: a retrospective cohort study

“…According to several studies, the treatment with a hinged external fixator is an effective supplement to open reduction and internal fixation (ORIF) to improve ligamentous and articular stability as well as the range of motion after an elbow dislocation [ 6 , 7 ]. Active and passive motion with slow stretching of the elbow during the early postoperative period is crucial in postoperative physical therapy to prevent the emergence of heterotopic ossification, which is seen in up to 75% of the cases [ 12 , 19 , 20 ]. An important determinant for a favorable clinical outcome is the compliance of the patient [ 2 ].…”

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

“…Indications for the use of an articulated external fixator include acute instability, instability after osteosynthesis or ligamentous repair, chronic subluxation, open fractures, fracture-dislocations in uncooperative patients and complex injuries in the elderly population. We have used external fixation in patients with elbow instability, fractures and dislocations with good results, 13 and several publications have reported on the use of hinged external fixation in the treatment of both acute and chronic elbow instability. 13 Yu et al reported the outcomes of 20 cases with acute complex instability of the elbow treated with hinged external fixation.…”

“…We have used external fixation in patients with elbow instability, fractures and dislocations with good results, 13 and several publications have reported on the use of hinged external fixation in the treatment of both acute and chronic elbow instability. 13 Yu et al reported the outcomes of 20 cases with acute complex instability of the elbow treated with hinged external fixation. 14 Interestingly, these authors did not repair the LCL when using a hinged external fixator.…”

“… 14 Interestingly, these authors did not repair the LCL when using a hinged external fixator. 13 , 14 …”

“…In our series, the most common soft tissue injury was the LCL complex, and the coronoid was involved as the most frequent bony injury of the elbow together with radial head fractures. 13 …”