Soft Tissue Constraint Injuries in Complex Elbow Instability: Surgical Techniques and Clinical Outcomes

Abstract

The surgical procedures for and outcomes of soft tissue constraint reconstruction in complex elbow instability have been rarely investigated. The purpose of this study was to analyze the clinical outcomes in a series of patients with complex elbow instability in whom the associated soft tissue constraint injures were identified and treated based on the pathoanatomic changes found intraoperatively. Forty-five patients (23 men and 22 women; mean age, 54 years) with complex elbow instability were followed prospectively. Surgical treatment included the anatomic reduction and internal fixation of any fracture and radial head replacement in Mason type III injuries. Soft tissue constraint lesions were then repaired based on the type of lesion (eg, proximal or distal ligament avulsion, middle-zone lesion, or presence of detached bony fragments). Posterolateral capsular lesions and common extensor and flexor origin injuries were also repaired. Patients were followed clinically and radiographically after a mean of 25 months. Functional range of motion was achieved in 39 (86%) patients. Average Mayo Elbow Performance Score; Disabilities of the Arm, Shoulder and Hand score; and American Shoulder and Elbow Surgeons shoulder score were 94, 5.6, and 89, respectively. At last follow-up, 42 (93%) patients showed no evidence of elbow instability, 2 (4%) patients had mild varus instability, and 1 (2%) patient had moderate posterolateral instability. The accurate identification of pathoanatomic changes of elbow soft tissue constraint lesions associated with complex elbow instability is an essential prerequisite to planning proper surgical treatment. The results of this study show that, in patients with complex elbow instability, once the fracture has been treated and each type of soft tissue constraint lesion adequately repaired, a high percentage of satisfactory functional outcomes may be achieved.

Modified lateral approach combined with medial percutaneous approach versus triceps tongue-shaped flap approach and bilateral triceps brachii approach for pin fixation in treatment of irreducible displaced pediatric supracondylar humeral fractures

“…The degree of soft tissue injury in surgery is one of the important factors that determine the recovery of elbow function. [19,20] For the elbow, the biggest benefit of reduced trauma in surgery is that the degree of soft tissue adhesion and contracture after surgery is less, and good extension and flexion function can be obtained. [21] For pediatric SHFs, the classical surgical approach is the TTSFA.…”

Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients

“…In this study, we prospectively analysed the recovery of ROM patterns in a large group of patients with CEI treated according to the current diagnostic/therapeutic algorithms, which recommend immediate postoperative rehabilitation [7][8][9][10][11][12][13][14]. The aims of our study were to investigate how and when such patients recover functional ROM, as well as the period during the rehabilitation programme in which the greatest degree of recovery occurs.…”

“…In the last decade, advances in our knowledge of functional anatomy combined with improved implants and surgical techniques have translated into better outcomes for patients affected by complex elbow instability (CEI) [6][7][8][9][10]. To date, the primary goals of surgery are the anatomical and stable ostheosynthesis of all articular fractures and the reconstruction of ligament injuries to recover elbow stability, which allow early motion and thus avoid elbow stiffness [9][10][11][12][13][14]. In this regard, several studies recommend that rehabilitation should be initiated as early as possible because an extended postoperative period of immobilisation is associated with significant functional impairment [15][16][17][18].…”

Clinical usefulness of proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS): prospective study of 39 cases

“…According to the PURCCS therapeutic algorithm (Table I), surgical treatment consisted of anatomic reduction and stable internal fixation of ulnar and radial fractures; metallic prosthesis in patients with irreparable radial head fractures; and reconstruction of injured collateral ligaments with suture anchors when the ligaments were detached from their origin or insertion or with side-to-side sutures in midsubstance lesions. 13,14 Lateral collateral ligament lesions were repaired in all patients, whereas medial collateral ligament lesions were repaired in patients with persistent instability after open reduction and internal fixation of all fractures and lateral collateral ligament reconstruction. A hinged external fixator was applied in patients with persistent elbow instability despite ligament and bone reconstruction.…”