Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Traumatic Elbow Instability and its Sequelae 18 articles


Radial Head Reconstruction in Elbow Fracture-Dislocation: Monopolar or Bipolar Prosthesis?

Robert U. Hartzler MD, MS, Bernard F. Morrey MD, Scott P. Steinmann MD, Manuel Llusa-Perez MD, Joaquin Sanchez-Sotelo MD, PhD

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.

The Management of Elbow Instability Using an Internal Joint Stabilizer: Preliminary Results

Jorge L. Orbay MD, Michael R. Mijares MD

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.

Anconeus Interposition Arthroplasty: Mid- to Long-term Results

Yaser M. K. Baghdadi MD, Bernard F. Morrey MD, Joaquin Sanchez-Sotelo MD, PhD

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

Yaser M. K. Baghdadi MD, Bernard F. Morrey MD, Shawn W. O’Driscoll MD, PhD, Scott P. Steinmann MD, Joaquin Sanchez-Sotelo MD, PhD

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.

Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable

Wendy E. Bruinsma MD, Thierry Guitton MD, PhD, David Ring MD, PhD

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?

Albert Yoon MBChB, Graham J. W. King MD, MSc, Ruby Grewal MD, MSc

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?

Jeffrey M. Pike MD, MPH, Ruby Grewal MD, MSc, George S. Athwal MD, Kenneth J. Faber MD, MHPE, Graham J. W. King MD, MSc

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.

Can We Treat Select Terrible Triad Injuries Nonoperatively?

Kevin Chan MD, MSc, Joy C. MacDermid BScPT, MSc, PhD, Kenneth J. Faber MD, MHPE, FRCSC, Graham J. W. King MD, MSc, FRCSC, George S. Athwal MD

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?

Andrew D. Duckworth MSc, MRCSEd, Neil R. Wickramasinghe MBChB, Nicholas D. Clement MRCSEd, Charles M. Court-Brown MD, FRCSEd(Orth), Margaret M. McQueen MD, FRCSEd(Orth)

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

David Ring MD, PhD, Wendy E. Bruinsma MD, Jesse B. Jupiter MD

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.

Comparative Study of Simple and Complex Open Elbow Dislocations

Jorge G. Boretto MD, Mario Rodriguez Sammartino MD, Gerardo Gallucci MD, Pablo De Carli MD, David Ring MD, PhD

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

Paul H. Yi BA, Alexander A. Weening MD, Sangmin R. Shin MD, Khalil I. Hussein BA, Paul Tornetta MD, Andrew Jawa MD

The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management.

Transverse Coronoid Fracture: When Does It Have to Be Fixed?

Robert U. Hartzler MD, Manuel Llusa-Perez MD, Scott P. Steinmann MD, Bernard F. Morrey MD, Joaquin Sanchez-Sotelo MD, PhD

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

Akash Gupta MD, David Barei MD, Ansab Khwaja BA, Daphne Beingessner MD

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.

Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?

Loukia K. Papatheodorou MD, PhD, James H. Rubright MD, Kathryn A. Heim MD, Robert W. Weiser MPAs, PA-C, Dean G. Sotereanos MD

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?

Tyler Steven Watters MD, Grant E. Garrigues MD, David Ring MD, PhD, David S. Ruch MD

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.

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Jimme K. Wiggers MD, Gijs T. T. Helmerhorst MD, Kim M. Brouwer MD, PhD, Maarten C. Niekel MD, Fiesky Nunez MD, David Ring MD, PhD

Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood.