La voie d’abord postérieure transtricipitale dans les luxations invétérées du coude

Posterior approach for surgical treatment of neglected elbow dislocation

“…But after multiple published series describing good results from open reduction, surgical treatment is now back in favor [2][3][4][5][6][7][8]11,[17][18][19]. Surgery is indicated based on how the patient tolerates the associated elbow stiffness [1,8,17,20] and on the age of the dislocation.…”

“…In cases where a maximum of 80 • of flexion can be achieved, despite using the shoulder and hand to compensate, the stiffness makes the arm non-functional. Most authors advocate only operating on the latter group of patients [1,2,4,5,7,8,17,18,20,21].…”

“…As with many others, we prefer to use the posterior approach instead of the combined lateral and medial approaches [2][3][4]7,8,11,13,[17][18][19]21]. The posterior approach provides good exposure to the posterior structures that are typically retracted; it is also easy to perform a V-Y triceps plasty and an ulnar nerve transposition, when needed.…”

“…If the triceps is significantly retracted, two main lengthening techniques are used: the V-Y triceps plasty described by Speed [11] (most commonly used [2][3][4]7,8,17,18]) and the procedure described by Vangorder [19]. The latter uses an Achilles tendon or fascia lata allograft after the triceps is sectioned transversely.…”

“…If these dislocations require surgical treatment, the surgeon has many options to consider: surgical approach, need for triceps lengthening (plasty), stabilization of the elbow after reduction, and repair of collateral ligaments [2][3][4][5][6][7][8].…”