A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Abstract

BackgroundElbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation.Methods/DesignThe design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36).DiscussionThe outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator.Trial RegistrationThe trial is registered at the Netherlands Trial Register (NTR1996).

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

“…3) [36]. After 6 weeks, the external fixator was removed in the outpatient department without any form of anesthesia.…”

“…All patients gave written informed consent to participate in this study, which was approved by the medical research ethics committees of all participating hospitals. The study protocol was published elsewhere [36].…”

American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version

“…2 The SF-36 is a generic health status questionnaire that gives an indication of health-related quality of life. [20][21][22][23][24][25][26][27] The SF-36 consists of 36 items (questions) and provides scores on eight dimensions (subscales): physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE) and general mental health (MH). These eight domains are combined into a physical component summary (PCS) and a mental component summary (MCS).…”

Complex elbow instability: surgical management of elbow fracture dislocations

“…22,23 Aligning a dynamic external fixator with the axis of flexion and extension of the elbow is not easy. If there are concerns regarding the axis, a static fixator may be used or the dynamic fixator may be locked with an additional bar.…”