The use of the internal joint stabiliser for elbow instability Report of two cases and systematic review

Abstract

The management of elbow fracture-dislocations is challenging. The internal joint stabiliser (IJS) (Skeletal Dynamics, Miami, FL) has been advocated as an alternative to traditional techniques. This article shares our initial clinical experience and provide a systematic review analysing the ability of the IJS to maintain radiographic joint reduction and the associated complication profile. Two cases of elbow fracture-dislocations treated at our centre using the IJS are presented. A systematic review of the literature was conducted using the online databases Medline, Scopus and EMBASE. Clinical studies reporting the maintenance of joint reduction after the use of IJS in patients with acute or chronic elbow instability were included. The two cases re- ported remained radiographically concentric at 6 months follow up without complications. 5 studies met the inclusion criteria and were included in the systematic review (total n=65). Only two patients across the studies had ongoing radiological in- stability (3%) and both were associated with coronoid insufficiency. The mean flexion-extension arc ranged from 106° to 135° and pronation- supination arc ranged from 138° to 151°. The mean DASH scores ranged from 16 to 37.3 and the mean Broberg and Morrey Functional score from 68.2 to 93. Complication rates in the case series ranged from 21% to 40%, the commonest complications were heterotopic ossification, neuropathy and infections. Initial reports into the use of the Internal Joint Stabiliser for elbow instability have shown a low incidence of residual radiological joint incongruency.

The Internal Joint Stabilizer of the Elbow: A Systematic Review of the Clinical and Biomechanical Evidence

“…Case descriptions and outcomes are shown in Table 4 . The IJS is reported for the indications of chronic dislocation, 18 , 19 Ehlers–Danlos Syndrome recurrent instability, 20 acute dislocations with coronoid fracture, 21 and terrible triad variant with Essex-Lopresti injury. 22 Reports describe the use of the IJS from a medial approach 23 and a posterior approach.…”

“…Schultz et al 18 reported on the IJS being used for chronic dislocation with gross instability. In a case of terrible triad injury, Jordan et al 21 reported on the IJS with removal of the device 4 months after surgery. Additionally, the same authors reported on the IJS being used in a coronoid fracture elbow dislocation case, but the device was not removed due to the patient’s choice.…”