Fracture-dislocations of the elbow joint - strategy for treatment and results

Abstract

Between January 1993 and December 1996, 41 patients with fracture dislocation of the elbow joint were treated in our department. In 28 patients (median age 46 years, range 15-77 years; 16 male, 12 female), a clinical and radiological follow-up was obtained after median 34 months (range 12-59 months). In addition to the humero-ulnar dislocation, isolated fractures were present in 13 patients and combined fractures in 15 (all with involvement of the radial head). Primary neurological deficits were found in 7 and open fractures in 3 patients. In 7 patients, primary definitive surgical therapy was carried out by open reduction and internal fixation. A two-step surgical management (initial closed reduction and immobilization, 5 patients with external fixator, 7 with plaster; secondary open surgical procedure) was performed in 12 and conservative treatment in 9 patients. According to the Leipzig Elbow Score, taking subjective, clinical and radiological criteria into consideration, 4 patients achieved 'excellent' and 5 patients a 'good' result. Ten patients were scored 'moderate' and 9 'poor'. The rate of secondary complications necessitating revision was 36%. Poor results were primarily caused by extensive initial soft-tissue damage, delayed definitive surgical therapy, and ectopic heterotopic ossification. In contrast, fracture localization and degree of arthrosis were not of significant importance for the final outcome. In fracture dislocations, the goal is a primary definitive surgical treatment aiming for early postoperative physiotherapy.

Monteggia and Monteggia-like-lesions: Classification, Indication, and Techniques in Operative Treatment

“…coronoideus remains problematic as the sufficient fixation of the little fragment is technically difficult. Insertion of a compression screw is almost impossible, and the fact also has to be considered that while the additional volar approach causes a better intra-operative overview, it also means an additional trauma, with a loss of motion range of the elbow due to scars, adhesions, and ossifications [38]. The use of a dynamic external fixation device to fix an unstable situation is also an option.…”

“…The basis for an early rehabilitation, including early mobilization within a defined arc of motion, is a stable reconstruction of the fracture [30][31][32][33][34][35][36][37][38][39][40]. If accomplished, physiotherapy can start immediately.…”

Current Concepts: Simple and Complex Elbow Dislocations – Acute and Definitive Treatment

“…By the same token, simple dislocations without any secondary injuries to the bone occur more often than complex dislocations [2]. The latter account for 15-20% of all elbow dislocations [8,9].…”

“…Further treatment applying physiotherapy exercises should then be performed on a movement scale for extension/flexion of 0°/20°/130°for a total of 3 weeks followed by an increase in extension. In this case, the patient cannot engage in athletic activities for a period of 6 months [9].…”

Ellenbogenverletzungen

“…Ursächlich sind persistierende Instabilitäten und Bewegungsdefizite durch verspä-tete operative Versorgung der ossären und ligamentären Begleitverletzungen bei initial schlechten Weichteilverhältnissen oder nach konservativem Therapieversuch mit langer Immobilisationsdauer. Deshalb sollten auch bei Ellenbogenluxationsfrakturen eine primäre operative Versorgung und frühfunktionelle Therapie angestrebt werden [6]. …”