Surgical management of unstable elbow dislocation without intra-articular fracture

Abstract

The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilisation in unstable elbow dislocations with pure capsulo-ligamentous injuries. Twenty-four patients who presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Anatomical repair was performed using metal anchor screws and the bone tunnel method. Ligament avulsion was noted in 55% for the medial collateral ligament, 80% for the lateral collateral ligament, 60% for the flexor tendon and 80% for the extensor tendon. The overall mean Mayo Elbow Performance Score was 93.2. Brachial artery injuries occurred in two elbows. Heterotopic calcification was noted in 14 patients and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with early rehabilitation provided satisfactory outcomes at two to four years postoperatively.Résumé Le but de cette étude est de décrire les lésions et de rapporter les résultats chez les patients présentant une luxation du coude avec lésion ligamentaire traitée par réparation ligamentaire et mobilisation précoce. Matériel et méthode: 24 patients présentant ce type de traumatisme sans lésion fracturaire intra articulaire ont été revus. Les lésions anatomiques ont été réparées avec soit une ancre soit une fixation ligamentaire par tunnels trans-osseux. Résultats: l'avulsion ligamentaire est notée dans 55% des cas pour le MCL, dans 80% pour le LCL, dans 60% pour le tendon fléchisseur et dans 80% dans le tendon extenseur. En tout état de cause, le score MEPS a été de 93,2. Une lésion de l'artère humérale a été observée sur deux coudes et des lésions de calcifications hétérotypiques ont été observées chez 14 patients avec, dans un cas, une arthrose sévère. Conclusion: cette étude montre l'influence que peut avoir la réinsertion ligamentaire dans ces lésions secondaires à une luxation du coude. Les réparations précoces associées à une réhabilitation également précoce permettent d'avoir des résultats satisfaisants après deux mois de suivi post-opératoire.

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.…”

Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches

“…A previous study showed that restoration of the damaged structures, including medial soft tissue structures, indicates excellent results based on MEPS in patients with TTE [20]. In TTE, the lateral collateral ligament, MCL, and anterior capsule are usually torn and soft tissues were injured, all of which are important determinants of elbow stability [21]. Our results show that lateral approach alone may not as beneficial as the other 2 approaches in terms of joint stability of the elbow, while the operation using anteromedial combined lateral approach has advantages of providing both bone and soft-tissue stability simultaneously, allowing early exercise and improving early functional recovery in TTE treatment [22].…”

Inestabilidad postraumática de codo. Revisión Bibliográfica

“…La indicación quirúrgica encontrada para la reparación ligamentaria en agudo fue la luxación o subluxación recurrente y la reducción no congruente en las radiografías de control (12) . Las técnicas usadas para la reparación ligamentaria fueron la reparación con túneles óseos con ethibón y la reinserción ligamentaria con anclas de titanio.…”