Treatment of unstable elbow dislocations with hinged elbow fixation—subjective and objective results

Hopf, Johannes Christof; Berger, Volker; Krieglstein, C. F.; Müller, Lars Peter; Koslowsky, Thomas C.

doi:10.1016/j.jse.2014.09.034

Cited by 37 publications

(33 citation statements)

References 36 publications

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“…Patients with simple elbow dislocations with ligament or capsular injuries and avulsion fractures of the coronoid (type I) according to Regan and Morrey were included. This definition of simple elbow dislocations is in accordance with recent studies [ 6 , 5 ]. Patients with associated articular fractures of the radial head, the olecranon or coronoid fractures type II and III, or relevant chondral lesions were excluded.…”

Section: Methodssupporting

confidence: 88%

“…Simple elbow dislocations with moderate instability under varus and valgus stress test under fluoroscopy had significantly more complications and a significantly worse clinical outcome compared to patients with slight elbow instability. Therefore, in younger and active patients with moderate elbow instability under stability testing, primary surgical treatment should be considered to avoid such complications and decrease the need for secondary surgery [ 7 , 6 , 5 ]. The results of this study emphasize the importance of an initial joint stability testing under fluoroscopy for the individual treatment decision.…”

Section: Discussionmentioning

confidence: 99%

“…A relative consensus exists in favour of a conservative treatment of simple elbow dislocations in the absence of any tendency of re-dislocation within the functional arc of the joint [ 3 , 4 ]. It is also a fact that unstable simple elbow dislocations with re-dislocation under stability testing benefit from early surgical ligament repair rather than by conservative treatment [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study

et al. 2015

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BackgroundConservative treatment of simple elbow dislocations can lead to complications such as persisting pain and restricted joint mobility. The current aim was to identify patients with deteriorated outcome after conservative treatment and to investigate a possible association with initial joint (in)stability.MethodsSixty-eight patients (mean age 37.1 ± 17.2 years) with simple elbow dislocations received conservative treatment. After closed reduction, joint stability was tested by varus and valgus stress under fluoroscopy. According to the findings under fluoroscopy, three different groups of instability could be identified: (1) slight instability (joint angulation <10°; n = 49), (2) moderate instability (angulation ≥10°; n = 19) and (3) gross instability. Patients with gross instability (re-dislocation under stability testing) were treated with primary surgical ligament repair and therefore excluded from this study. Additionally, MRIs and radiographs were analysed regarding warning signs of instability such as the drop sign and joint incongruence. Main outcome parameters were the Mayo Elbow Performance Score (MEPS), range of motion (ROM), complications and revision rates.ResultsAfter 40.7 ± 20.4 months, the overall MEPS was excellent (94.2 ± 11.3) with a trend of slightly worse clinical results in group 2 (95.8 ± 9.0 vs. 90.0 ± 15.2 points; p = 0.154). In group 1, significantly more patients achieved an excellent result regarding the MEPS scoring system (77.6 vs. 52.6 %; p = 0.043) and elbow extension was significantly worse in group 2 (5.3 ± 9.9° vs. 1.4 ± 3.0°; p = 0.015). Seven treatment complications occurred in group 2 (36.8 %) compared with two in group 1 (4.1 %, p < 0.0001). Six patients (8.8 %) needed secondary surgery with an 8.4-fold higher risk for revision surgery in group 2 (p = 0.007). The presence of a positive drop sign or joint incongruence led to higher odds ratio (OR) for complications (OR = 15.9) and revision surgery (OR = 10.3).ConclusionsThis study demonstrates that patients with moderate joint instability after simple elbow dislocation have a significantly worse clinical outcome, more complications and a higher need for secondary revision surgery following conservative treatment compared to patients with slight elbow instability.

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Section: Methodssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study

et al. 2015

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“…Only two recurrent dislocations have been reported as case reports [26,27]. In recurrent dislocations in adults, hinged fixators are applied after soft tissue relaxation, but the results are unknown [28]. In one patient in the present study with no additional fracture, reduction was performed due to recurrent dislocation.…”

Section: Discussionmentioning

confidence: 74%

Clinical and functional outcomes of pediatric elbow dislocations: Level 1 tertiary trauma center experience

Agar¹,

Sahin²,

Gülabi³

et al. 2022

Journal of Surgery and Medicine

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Background/Aim: Traumatic elbow dislocations have been reported as uncommon in pediatric population. Because of low frequency, there are not many studies on the subject in the literature. The aim of this study was to retrospectively evaluate the radiological and functional results of pediatric patients treated for elbow dislocations in a level-1 tertiary trauma center and to compare the results of simple and fractured dislocations. Methods: This is a retrospective cohort study of a single center experience diagnosed with pediatric elbow dislocations between 2015 and 2019. The cases were evaluated by dividing them into two groups as simple dislocations and fracture dislocations. Demographic features, injury mechanism, treatment, complications and Mayo elbow performance score (MEPS) were evaluated. Results: Fifty-seven patients, (46 male/ 11 female), were included in the study, with a mean age of 11.1 (3-15) years. Mean follow up time was 27.2 (12-51) months. While 30 patients had fracture dislocations, 27 patients had simple dislocations. Of 30 patients with fracture dislocations, 19 were operated. Nonunion in the medial epicondyle in five patients, AVN (avascular necrosis) in radial head in two patients, heterotrophic ossification in one triceps, and recurrent dislocation in one patient were detected. According to MEPS, 42 (73%) of 57 patients were excellent, 12 (21%) good, one (2%) moderate, and two (4%) poor. According to MEPS, functional results of simple dislocations were found to be better than those of fracture-dislocations, and this result was statistically significant (P<0.05). Conclusion: Elbow dislocations in children can be treated with good results if they are accurately diagnosed and if concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures can be achieved. Simple dislocations are easier to manage and functional results are better, whereas the treatment of fractured dislocations is more complex and complications are more common in follow-up.

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“…En la serie de Anakwe (9) se usaron 3 tipos de tratamiento conservador con plan de movilización precoz. Se observó solo un 8% de inestabilidad subjetiva al fi nal del seguimiento; los autores concluyen que la movilidad precoz no se asoció a un aumento de la inestabilidad subsecuente como se pensaba antes.…”

Section: Tratamientounclassified

Inestabilidad postraumática de codo. Revisión Bibliográfica

Fratelli

Casales

Oehler

et al. 2018

An Facultad Med (Univ Repúb Urug)

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Resumen:Introducción: Las luxaciones constituyen del 10 % al 25 % de todas las lesiones en el codo. Aproximadamente el 15% de los pacientes que la han sufrido quedan con algún síntoma compatible con inestabilidad. El objetivo de este trabajo es revisar en la literatura los diferentes tratamientos propuestos para esta complicación luego de una luxación simple de codo.Materiales y Métodos: Se realizó una búsqueda en las bases de datos Medline y Bireme para estudios de los últimos diez años. Se seleccionaron los artículos que cumplieron los criterios de inclusión y exclusión, extrayendo de ellos se seleccionaron datos relevantes y resultados. La búsqueda arrojó un total de 596 artículos de los cuales 10 cumplían con los criterios de inclusión propuestos al iniciar la búsqueda.Discusión: Se analizaron y compararon las tasas de inestabilidad luego de la luxación, los diferentes tipos de tratamiento y las complicaciones.Conclusión: Existe consenso en la literatura analizada de que debe realizarse un examen de estabilidad del codo en agudo para defi nir el tratamiento. En cuanto al tratamiento en los codos que se presentan inestables la literatura es variable y faltan estudios comparativos para realizar recomendaciones. Palabras Clave:luxación de codo, inestabilidad de codo. Abstract:Introduction: Dislocations are 10% to 25% of all elbow injuries. Up to 15% of patients with symptoms of instability can be observed. The aim of this study is to review in the literature the diff erent treatments proposed for this complication after a simple elbowdislocation.Materials and Methods: The search was conducted on Medline (PubMed interface) and Bireme including the last ten years studies. Articles that met the inclusion and exclusion criteria were selected and the relevant data and results were extracted. We found a total of 596 articles, 10 met the

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Treatment of unstable elbow dislocations with hinged elbow fixation—subjective and objective results

Cited by 37 publications

References 36 publications

Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study

Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study

Clinical and functional outcomes of pediatric elbow dislocations: Level 1 tertiary trauma center experience

Inestabilidad postraumática de codo. Revisión Bibliográfica

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