Fixation of the Coronoid Process in Elbow Fracture-Dislocations

Garrigues, Grant E.; Wray, Walter H.; Lindenhovius, Anneluuk L.C.; Ring, David; Ruch, David S.

doi:10.2106/jbjs.i.01673

Cited by 168 publications

(130 citation statements)

References 17 publications

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“…At 2 years, the median QuickDASH score of 7 is consistently lower than QuickDASH scores reported in previous articles on similar types of injuries treated with a hinged fixator (P 25 -P 75 , 15-28 points) [8,13,32,34] or treated with ligament repair (P 25 -P 75 , 15-28 points) [6,8,10,42]. The slight disability is paralleled by high scores on the additional patient-reported functional outcome measures.…”

Section: Discussionmentioning

confidence: 60%

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

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

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Section: Discussionmentioning

confidence: 60%

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

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…First, removal of the radial head for planned arthroplasty allows for better visualization of the coronoid fracture fragment. The importance of adequate coronoid fixation in terrible triad injuries has been documented previously [5,7,8,11,21]. Improved visualization through the existing lateral incision may potentially allow for better reduction and fixation, regardless of fixation technique.…”

Section: Discussionmentioning

confidence: 95%

“…We have previously published a report on this series of patients, specifically evaluating surgical outcomes based on the fixation method of the coronoid fracture fragment [7]. That analysis revealed that a suture lasso technique was superior to suture anchors or lag screws before and after LUCL repair.…”

Section: Discussionmentioning

confidence: 98%

“…A perioperative current procedural terminology code database was used to identify patients treated for terrible triad injuries by the two senior authors (DR, DSR) between 1996 and 2008. A subset of the study sample used for this research has been previously presented in other contexts [3,5,7]. In the current study, we had a multicenter cohort to broaden the patient sample and evaluate the management of terrible triad injuries in a different context.…”

Section: Methodsmentioning

confidence: 99%

“…We believe, if the elbow remains concentrically located on a lateral fluoroscopic image while hanging in this position, it is stable. This previously published test was the basis of our intraoperative assessment of stability [7]. It was performed both before and after the LUCL was addressed.…”

Section: Surgical Techniquementioning

confidence: 99%

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Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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110

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Background Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial. Questions/purposes We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Methods Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Complete followup was available on 87% (39 of 45 patients).

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Elbow Dislocations

Howard

Pollock

2021

Evidence‐Based Orthopedics

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Fixation of the Coronoid Process in Elbow Fracture-Dislocations

Abstract: For terrible triad injuries, greater stability with fewer complications was achieved with use of the suture lasso technique for coronoid fracture fixation.

Cited by 168 publications

References 17 publications

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

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

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Elbow Dislocations

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