Elbow Instability: The Orthopedic Approach

Abstract

In recent years significant progress has been made in the diagnosis and treatment of elbow instability. Elbow instability represents a spectrum from the acute traumatic dislocation to chronic laxity resulting in transient joint subluxation. In general, acute elbow dislocations represent the second most common joint dislocation in the adult population and the most common joint dislocation in the pediatric age group. This manuscript reviews the anatomy of the elbow joint as it relates to elbow instability. It then discusses the mechanism and classification of elbow instability and outlines treatment options available for acute and chronic elbow instability.

Traumatic Elbow Instability

“…3 The importance of the MCL may be emphasized because its contribution to elbow stability is much easier to isolate in cadavers. 2,4 Injury to the lateral collateral ligament (LCL) is a consistent feature of traumatic elbow instability, and problems related the LCL are responsible for a large proportion of residual subluxation or recurrent dislocation. 5,6 The LCL and MCL are often referred to as complexes, to emphasize that their contributions to elbow stability are enhanced by adjacent capsuloligamentous, fascial, and musculotendinous structures.…”

“…4 The anterior capsule also makes a substantial contribution to elbow stability. 2 Dynamic forces from the muscles that cross the elbow joint provide an important element of stability when other stabilizing structures have been injured. 7,8 …”

MR Imaging of Trauma: Elbow and Wrist

“…The first stage (stage 1) represents posterolateral rotatory instability and is characterized by disruption of the lateral ulnar collateral ligament and resultant posterolateral subluxation of the radius and ulna relative to the humerus. 11,12 The next stage (stage 2) involves progression of injury with disruption of the anterior and posterior capsule and the radial collateral ligament (Fig. 7).…”

Additional external hinged fixator after open repositioning and internal fixation of acute elbow instability in non-compliant patients

“…Different types of external fixation devices offer controlled hinged motion using the combination of stable reduction of the joint and possibility of concentric (isometric) early functional mobilization. 26–34 …”