Primary Ligament Repair for Elbow Dislocation

Abstract

Few have been reported on the role of early primary ligament repair for acute unstable elbow dislocation. The purpose of this study is to evaluate the clinical outcome of early primary ligament repair for unstable elbow dislocation followed by protected early joint mobilization exercise.Thirteen patients who underwent operative treatment due to unstable elbow dislocation without associated fracture were retrospectively reviewed. There were 11 male and 2 female with average age of 37 years (range; 18-72 years). Surgical indications of the unstable elbow were subluxation or non-congruent elbow joint on the radiographs following closed reduction. Elbow dislocation which required extension block splint over 45 degrees to maintain reduction was considered as unstable elbow dislocation.In ten patients, full stability was restored only after both medial and lateral structures were re-attached. In two patients, only lateral structure (LCLC and common extensor tendon) was repaired and in one patient, only medial structure (MCL and flexor pronator tendon) was repaired for stability. Overall mean functional Mayo Elbow Performance Score was 93.5 (range; 70-100). No elbow was dislocated or subluxated after operation. All ten patients returned to previous work level in average of 3.5 months. Heterotopic calcification was noted in six patients and three had mild ulnar nerve symptoms after operation.In conclusion, primary ligament repair in acute unstable elbow dislocation were successful, because surgery achieved sufficient stability to allow early exercise (Keio J Med 57 (2) : 99 -104, June 2008)

The Treatment of Simple Elbow Dislocation in Adults

“…The results of the meta-analysis show that severity of soft tissue injury is correlated with prognosis, although the extent to which conclusions can be drawn from the studies on this subject is limited by their retrospective design (10)(11)(12)(13)34).…”

“…Better understanding of anatomy and biomechanics has led to new developments in elbow surgery in recent decades. Research into posterolateral rotatory instability in particular (36) has made a contribution to this and casts doubt on the continuing relevance of the conclusions of Josefsson et al (21), especially as recent clinical research shows good to excellent outcomes, measured in terms of clinical scores, following surgery for acute elbow instability (8,(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

“…However, thanks to scientific advances options for surgical reconstruction of the soft tissues of the elbow have multiplied in recent years (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), so discussion of standard treatment for simple elbow dislocation has been rekindled.…”

Complex and Unstable Simple Elbow Dislocations: A Review and Quantitative Analysis of Individual Patient Data~!2009-10-23~!2009-12-20~!2010-02-17~!

“…The systematic review included 10 observational studies encompassing 170 patients with complex elbow dislocations (n=134, 78.8%) or unstable simple elbow dislocations (n=36, 21.2%). Five studies included only complex elbow dislocations [17-21], two studies only simple elbow dislocations [22, 23] and three studies included complex elbow dislocations as well as unstable simple dislocations [14, 24, 25]. The two studies with only unstable simple elbow dislocations published individual data from the same patients [22, 23], therefore the study with the largest sample size was included [23].…”

Akute Kapsel-Band-Verletzungen des Ellenbogens

“…Nervenschäden besteht für eine persistierende Instabilität mit Reluxation innerhalb des funktionellen Bogens bzw. für jede Art der Gelenkinkongruenz/Subluxation nach primärer Reposition die eingehende Empfehlung zur operativen Therapie [9,10,17,22,24].…”