Using External Joint Stabilizer – Elbow (EJS-E) for treating elbow instability—biomechanical assessment and clinical outcomes

Abstract

Background This study aimed to evaluate the outcome of using an External Joint Stabilizer – Elbow (EJS-E) for persistent elbow instability based on biomechanical experiments and analysis of clinical results. Methods An EJS-E was used in 17 elbow instability patients. The median follow-up was 26 months (range, 12–42 months). We evaluated the flexion–extension and pronation-supination movement arcs, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Broberg and Morrey classification system, and occurrence of complications in these patients. Moreover, construct stiffness and maximum strength tests were performed to evaluate the strength of the fixation techniques. Results The final median range of the extension-to-flexion and pronation-to-supination arc of the elbow was 135° (range, 110°–150°) and 165° (range, 125°–180°), respectively. The VAS pain scores were > 3 in two patients. The median MEPS was 90 (range, 80–100 points). Five patients showed signs of grade I post-traumatic osteoarthritis according to the Broberg and Morrey radiographic classification system, while grade II changes were observed in three patients. Complications included axis pin loosening with pin-tract infection in two patients, transient ulnar nerve symptoms in two patients, heterotopic ossification in two patients, and suture anchors infection in one patient. Based on the biomechanical testing results, the EJS-E exhibited higher stiffness and resisting force in varus loading. It was 0.5 (N/mm) stiffer and 1.8 (N·m) stronger than the internal joint stabilizer (IJS) by difference of medians (p < 0.05). Conclusions Biomechanical and clinical outcomes show that EJS-E via the posterior approach can restore mobility and stability in all patients, thus serving as a valuable alternative option for the treatment of persistent instability of the elbow.