Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation

Sørensen, Anne Kathrine Belling; Søjbjerg, Jens Ole

doi:10.1016/j.jse.2011.06.002

Cited by 59 publications

(43 citation statements)

References 34 publications

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“…The flexion-extension arc result was better than expected. The 118°flexion-extension arc in our patients was in line with those reported for patients treated with ligament repair (P 25 -P 75 , 112°-117°) [6,8,10,42], but consistently greater than for patients treated with a hinged external fixator (P 25 -P 75 , 93°-99°) [31,32,38,41]. The latter could be because of the mean time to fixator placement.…”

Section: Discussionsupporting

confidence: 87%

“…In the current study, most patients reported the maximum score (100 points) for the MEPI. MEPI scores in previous studies of patients with complex elbow injuries range between 75 and 93 [6,11,28,32,38,41]. The flexion-extension arc result was better than expected.…”

Section: Discussionmentioning

confidence: 73%

“…A hinged fixator may be used to achieve this. Previous studies reported promising but variable results regarding ROM and patientreported outcome scores [16,18,31,33,37,38]. The variability in reported results may have been a function of the shortcomings of retrospective analysis.…”

Section: Discussionmentioning

confidence: 98%

“…Previous reports on ROM and patient-reported outcome scores after the use of a hinged external fixator in these types of injuries show promising but varying results [16,18,31,32,34,38,39]. This is mostly because the majority of these studies were small retrospective case series.…”

Section: Rationalementioning

confidence: 99%

“…The goal in management of complex elbow dislocations is to reconstruct a stable joint that tolerates a functional after-treatment [19,28,33,38]. Elbows with residual instability frequently are treated with primary ligament repair with or without plaster immobilization.…”

Section: Introductionmentioning

confidence: 99%

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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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