Failure to restore joint congruence is likely to be associated with stiffness, reduced range of motion, instability and future degenerate change [13]. However when a fracture has occurred, the elbow may remain unstable if surgery is not performed. This gives a calculated tendon length (1/2πD) of 53 mm for the intra-articular portion (B) of the graft. Management of unstable elbow fractures muscle groups, are any muscles crossing the elbow joint that exert a compressive force on the joint[1]. The primary disadvantage of this static approach is in the tendency of the elbow to stiffen following severe injury. The posterior aspect of the humerus is then visible through the triceps split. et al. Int Orthop. In unstable elbow dislocation, PLDL and PMDL are caused by different mechanisms following damage to different structures. Static stabilisation of the elbow is relatively technically simple and has been described with the use of external fixation or trans-articular pinning. 1. Ligamentous repair of acute lateral collateral ligament rupture of the elbow, Outerbridge-Kashiwagi’s method for arthroplasty of osteoarthritis of the elbow—44 elbows followed for 8–16 years, Zantop T, Ferretti M, Bell KM, Brucker PU, Gilbertson L, Fu FH (2008), Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees: intra-articular study in a goat model, Qi L, Chang C, Jian L, Xin T, Gang Z (2011), Effect of varying the length of soft-tissue grafts in the tibial tunnel in a canine anterior cruciate ligament reconstruction model, Long-term sequelae of simple dislocation of the elbow, Rafai M, Largab A, Cohen D, Trafeh M (1999), Pure posterior luxation of the elbow in adults: immobilization or early mobilization. The third part is in the bone tunnel in the coronoid process and is fixed at 15 mm. 1-A). Most commonly, dynamic stabilisation is achieved with soft tissue repair or reconstruction or hinged external fixation. The pathomechanics of dislocation proposed by Horii describes sequential failure of the soft tissues from lateral to medial. These symptoms occur during the act of extension and supination, especially when an axial load is applied through the upper extremity. The length of B is assumed to be half the circumference of the ring (1/2πD). The proximal ulna must be anatomically reduced and internally fixed, the radial head must be repaired or replaced, and substantial coronoid fractures must be repaired or reconstructed. Drilling of the graft tunnel in the ulna through the olecranon fossa. Following the reconstruction it was not possible to re-dislocate or sublux the ulnohumeral joint regardless of the elbow position from full extension to full flexion. HHS A 4 mm tunnel is then drilled beginning at the tip of the coronoid process and traversing the ulna to exit through the dorsal cortex of the ulna (Figure 4). The triceps tendon is exposed and a 4 mm wide central strip extending proximally from olecranon to the musculotendonous junction is marked out (Figure 1). Repetitive strain—… Methods: We assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. In this rare situation operative treatment is indicated. Unstable elbow dislocations J Shoulder Elbow Surg 2008; 17: 281-86. Access to the anterior aspect of the joint through a window in the olecranon fossa is described in the Outerbridge-Kashiwagi (OK) method for the debridement of osteophytes in degenerative joint disease [10]. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Initially we believe that the most appropriate role for this procedure is on the cohort of patients who would currently be considered unsuitable for dynamic ligamentous repair or external fixation. Diagnosis of elbow fracture patterns on radiographs: interobserver reliability and diagnostic accuracy. [26] Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD. Ligamentous repair can be indicated in high demand patients or if the elbow remains unstable following a closed reduction. Anterior view of the graft in its final position. These bones are the arm bone (humerus) and two forearm bones (radius and ulna). Acute Simple Elbow Dislocations . The importance of the anterior band of the MUCL and the LUCL has been highlighted by O’Driscoll [23]. We chose 15 mm as the length of graft in the tunnel because this has been reported as a safe length in anterior cruciate ligament reconstruction [11, 12]. Despite reduction and fixation of associated fractures, significant soft-tissue injury that occurs as a result of dislocation may result in residual instability. 2008 Sep 19;1(1):168. doi: 10.1186/1757-1626-1-168. 1–3 In this rare situation operative treatment is indicated. The vast majority of simple dislocations can be reduced closed with sedation and will remain reduced and stable [4]. Although feasible on all unstable simple dislocations, further biomechanical testing including cyclic loading of the tendon would be required before the potential applicability of this technique is known. The tendon strip is divided proximally at the musculotendonous junction and longitudinally to its insertion. EPIDEMIOLOGY AND TREATMENT OF MONTEGGIA LESION IN ADULTS: SERIES OF 44 CASES. (12th Annual Meeting of the OTA); - Dislocation w/ Radial Head Frx - Dislocation + Medial Epicondyle Frx: - following closed reduction, the medial epicondyle fracture is classified with regard to displacement; the display of certain parts of an article in other eReaders. Please enable it to take advantage of the complete set of features! In 3B the anterior bundle is ruptured and in 3C the elbow remains unstable after reduction even in 90 degrees of flexion [22]. The triceps tendon is only exceptionally rarely injured in simple elbow dislocation [26] and so the graft is strong and should avoid the need for additional stabilisation of the joint. Introduction: A small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. The dislocation is classified as simple or complex depending on the presence or absence of an associated fracture [1]. Elbow dislocation which required an extension block splint over 45°to maintain reduction was considered as an unstable elbow dislocation as previously described by Morrey and O'Driscoll [15, 21]. In 3A the posterior bundle of the medial ulnar collateral ligament (MUCL) is ruptured but the anterior bundle is intact. Home; About Journals. SW17 0QT UK. It has been shown that in unstable simple elbow dislocation most if not all the primary soft tissue stabilisers of the joint are ruptured . Malpositioning of the isometric LCL or the non-isometric MUCL [24] will result in stiffness or instability depending on the position of the elbow during tensioning of the repair. Complex and Unstable Simple Elbow Dislocations: A Review and Quantitative Analysis of Individual Patient Data. If the elbow appears to subluxate or dislocate, put in a backslab with elbow flexed 90° and do check x- ray (AP / Lat). There are potential drawbacks specific to this technique. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly Poglia P, Wehrli L, Steinmetz S, Zermatten P. J Med Case Rep. 2016 May 11;10(1):121. doi: 10.1186/s13256-016-0904-9. Results are generally good, although a small percentage of patients may develop chronic instability. The distance A was measured with callipers. The elbow joint is further stabilized by ligaments that helps hold the bones together. MH, TB and JB declare no conflict of interest in relation with this paper.  |  This site needs JavaScript to work properly. This cohort may be medically unsuitable for prolonged surgery or assessed as not able to tolerate external fixation. The free ends of the whip stitch are passed through the fenestration in the olecranon fossa and through the tunnel in the ulna with the aid of a suture passer. NLM These injuries often require surgical treatment to render the elbow stable enough to allow early motion. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position. This technique utilises the harvest of a central strip of triceps tendon which is distally based and remains attached at its insertion. Radial nerve palsy after the use of an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow: a case report and review of the literature. Dynamic stabilisation aims to avoid the problems of immobilisation by allowing early functional rehabilitation. Patients with PLRI may present with a spectrum of different symptoms ranging from vague pain in the elbow to recurrent posterolateral dislocations. By Gregory J. Zeiders, DO, and Minoo K. Patel, MBBS, MS, FRACS Introduction omplex fracture-dislocations of the elbow can often be either irreducible or unstable, with an inability to hold the reduction or with the delayed development of sub- luxation or dislocation. 18. The elbow is the second most frequently dislocated large joint. Gently move elbow through its range of motion. The osseo-tendonous ring constructed around the trochlea provides immediate stability with concentric reduction such that the difficulties of aligning the ulna with the axis of rotation of the elbow are negated. We are experimenting with display styles that make it easier to read articles in PMC. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs. Good results have been reported [19, 20]. Three bones come together to make up the elbow. Elbow stability must be restored by addressing the specific components of the injury. The isometric relationship between the articular proximal ulna and the axis of rotation of the elbow is restored allowing a full range of movement. There are three common ways that a shoulder can become unstable. More than 30 mm of joint distraction was possible and greater than 90 degrees varus or valgus angulation was possible. Results: All 20 elbows had sufficient triceps tendon length to complete the new technique. The triceps tendon may be at risk of donor site morbidity including pain and weakness similar to that seen following patella tendon harvest for ACL reconstruction [27]. This is primarily a feasibility study to demonstrate that our idea is technically possible. A small incision is made over the tip of the drill at the point where it penetrates the dorsal cortex of the ulna. 2016 Jan-Feb;24(1):48-51. doi: 10.1590/1413-785220162401152249. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability. Complex fracture-dislocations of the elbow are treated surgically and are challenging injuries to manage. We dissected 10 cadavers (20 elbows). Their healing potential may be reduced due to comorbidities such as diabetes or medications such as steroids. Introduction: Instability after an elbow dislocation or fracture-dislocation is unusual but very difficult to treat effectively. This represents the diameter of our proposed osseo-tendonous ring. Simple dislocations have an incidence of 5–6 per 100,000 [2, 3]. 8 , 9 The dislocations may be complex or simple. The elbow is the second most commonly dislocated major joint in the body after the shoulder, with an annual incidence of 6.1 dislocations per 100 000 population. An elbow dislocation is defined as “simple” if there is no associated fracture. Our data suggest that unstable simple elbow dislocation occurs in some elderly women after low energy falls and some younger patients with high energy injury mechanisms. - ref: Unstable elbow dislocations and fracture-dislocation: Temporary trans-articular fixation. mechanism for posterolateral dislocation . Elbow stability must be restored by addressing the specific … Joint distraction and stressed varus and valgus angulation were recorded before and after the reconstruction with a rule and a goniometer.

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