Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study.

Josefsson, Per Olof; Gentz, C F; Johnell, Olof; Wendeberg, Bo

doi:10.2106/00004623-198769040-00018

Cited by 283 publications

(114 citation statements)

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“…7 Half of the patients had normal elbows; one third had some loss of motion, mainly extension. This related to the duration of post-reduction immobilization.…”

Section: Discussionmentioning

confidence: 98%

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Primary Ligament Repair for Elbow Dislocation

Jeon¹,

Kim²,

Kim³

2008

Keio J. Med.

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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)

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“…7 Half of the patients had normal elbows; one third had some loss of motion, mainly extension. This related to the duration of post-reduction immobilization.…”

Section: Discussionmentioning

confidence: 98%

“…2,6,7 However, few have been reported on the role of early primary ligament repair for acute unstable elbow dislocation. 7,8 The purpose of this study is to analyze and report the clinical outcome of early primary ligament repair for unstable elbow dislocation followed by protected early joint mobilization exercise.…”

Section: Introductionmentioning

confidence: 99%

Primary Ligament Repair for Elbow Dislocation

Jeon¹,

Kim²,

Kim³

2008

Keio J. Med.

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“…From experience with ligamentous injuries to the knee and ankle, it is known that ligaments have the ability to heal and to form a scar-like neoligament. Nevertheless, few data are available supporting a nonoperative approach to ligamentous injuries after complex dislocations of the elbow [8,13,15,16].…”

Section: Discussionmentioning

confidence: 99%

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

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“…The treatment of this injury includes orthopedic reposition, immobilization and adequate rehabilitation. This treatment has good prognosis with possible mild restrictions of movement (4,5).…”

Section: Introductionmentioning

confidence: 96%

Surgical Treatment of an Open Elbow Dislocation with Vascular Injury: A Case Report

Stojiljković¹,

Jovanović²,

Golubović³

et al. 2017

Acta Facultatis Medicae Naissensis

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Open elbow dislocations with vascular injury are rare injuries and they most commonly occur after a fall from a high or in sports accidents. Close anatomic proximity of the joint to the neurovascular structures put them at risk of concomitant injury. The aim of this paper is to present the method of treatment of this severe injury.Herein we present a case of a female patient, 43 years old. She had suffered an open elbow dislocation with vascular injury as a result of a fall from the height of 1.5 meters. Seven hours after sustaining the injury and short preoperative preparation, reposition of the elbow, reconstruction of the vascular injury, adequate surgical treatment of the wound and external fixation of the elbow with the Mitković type external fixator were performed under general anesthesia. Four weeks after elbow stabilization with the external fixation, the external fixator was removed. The neurovascular status and final functional result of the treatment after six mounts were good. Urgent reposition, artery and vein reconstruction, and external fixation are essential in achieving good results in patients with open cubital dislocation accompanied with vascular injury. The Mitković type external fixator provides fast and stable fixation of the elbow after reposition and good conditions for wound care.

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Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study.

Cited by 283 publications

References 0 publications

Primary Ligament Repair for Elbow Dislocation

Primary Ligament Repair for Elbow Dislocation

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Surgical Treatment of an Open Elbow Dislocation with Vascular Injury: A Case Report

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