Symposium: Traumatic Elbow Instability and its Sequelae 18 articles
Monopolar and bipolar radial head prosthetic arthroplasties have been used successfully to treat elbow fracture-dislocation with unsalvageable radial head fractures. The relative stability of these two designs in different clinical situations is a topic of ongoing investigation.
Nonsurgical and surgical treatments such as immobilization, transarticular pinning, and hinged or nonhinged external fixation have been used to treat unstable elbows. These methods all have drawbacks. We thought that a bent Steinmann pin introduced through the axis of ulnohumeral rotation and attached to the ulna could provide an improved method of treatment and that this could result in the development of a proper internal joint fixator that may have widespread application.
Radiocapitellar arthritis and/or proximal radioulnar impingement can be difficult to treat. Interposition of the anconeus muscle has been described in the past as an alternative option in managing arthritis, but there are little published data about relief of pain and restoration of function over the long term in patients treated with this approach.
Revision Allograft Reconstruction of the Lateral Collateral Ligament Complex in Elbows With Previous Failed Reconstruction and Persistent Posterolateral Rotatory Instability
Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown.
Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation).
Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?
While good results have been reported with both nonoperative and operative treatment of isolated displaced partial radial head fractures, there remains considerable disagreement about the role of surgery in the management of these injuries.
Open Reduction and Internal Fixation of Radial Head Fractures: Do Outcomes Differ Between Simple and Complex Injuries?
Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive.
While the majority of terrible triad elbow injuries (ulnohumeral dislocation with radial head and coronoid fractures) are managed surgically, nonoperative treatment may be appropriate in selected patients, but results with this approach have been limited by very small studies.
Radial Head Replacement for Acute Complex Fractures: What Are the Rate and Risks Factors for Revision or Removal?
When treating complex radial head fractures, important goals include prevention of elbow or forearm instability, with restoration of radiocapitellar contact essential. When open reduction and internal fixation cannot achieve this, radial head replacement is routinely employed, but the frequency of and risk factors for prosthesis revision or removal are not well defined.
Complications of Hinged External Fixation Compared With Cross-pinning of the Elbow for Acute and Subacute Instability
Elbows that are unstable after injury or reconstructive surgery often are stabilized using external fixation or cross-pinning of the joint supplemented by cast immobilization. The superiority of one approach or the other remains a matter of debate.
Open elbow dislocations are rare injuries. Most of the evidence related to these dislocations is found in case reports or in series with closed injuries. We reviewed the experiences of three centers in the treatment of open elbow dislocations.
Injury Patterns and Outcomes of Open Fractures of the Proximal Ulna Do Not Differ From Closed Fractures
The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management.
After elbow fracture-dislocation, surgeons confront numerous treatment options in pursuing a stable joint for early motion. The relative contributions of the radial head and coronoid, in combination, to elbow stability have not been defined fully.
Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury
Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Studies to date have consisted of small sample sizes and used heterogeneous surgical techniques, which render comparisons difficult and unreliable.
The “terrible triad” of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that type II coronoid fractures are stable unless the radial head is removed and not replaced.
Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?
Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial.
Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood.