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. 2009 Aug;33(4):1141-7.
doi: 10.1007/s00264-008-0624-x. Epub 2008 Aug 2.

Surgical management of unstable elbow dislocation without intra-articular fracture

Ivan Micic  1 , Shin-Yoon Kim, Il-Hyung Park, Poong-Taek Kim, In-Ho Jeon
Affiliations

Surgical management of unstable elbow dislocation without intra-articular fracture

Ivan Micic et al. Int Orthop. 2009 Aug.

Abstract
in English, French

The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilisation in unstable elbow dislocations with pure capsulo-ligamentous injuries. Twenty-four patients who presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Anatomical repair was performed using metal anchor screws and the bone tunnel method. Ligament avulsion was noted in 55% for the medial collateral ligament, 80% for the lateral collateral ligament, 60% for the flexor tendon and 80% for the extensor tendon. The overall mean Mayo Elbow Performance Score was 93.2. Brachial artery injuries occurred in two elbows. Heterotopic calcification was noted in 14 patients and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with early rehabilitation provided satisfactory outcomes at two to four years postoperatively.

Le but de cette étude est de décrire les lésions et de rapporter les résultats chez les patients présentant une luxation du coude avec lésion ligamentaire traitée par réparation ligamentaire et mobilisation précoce. Matériel et méthode: 24 patients présentant ce type de traumatisme sans lésion fracturaire intra articulaire ont été revus. Les lésions anatomiques ont été réparées avec soit une ancre soit une fixation ligamentaire par tunnels trans-osseux. Résultats: l’avulsion ligamentaire est notée dans 55% des cas pour le MCL, dans 80% pour le LCL, dans 60% pour le tendon fléchisseur et dans 80% dans le tendon extenseur. En tout état de cause, le score MEPS a été de 93,2. Une lésion de l’artère humérale a été observée sur deux coudes et des lésions de calcifications hétérotypiques ont été observées chez 14 patients avec, dans un cas, une arthrose sévère. Conclusion: cette étude montre l’influence que peut avoir la réinsertion ligamentaire dans ces lésions secondaires à une luxation du coude. Les réparations précoces associées à une réhabilitation également précoce permettent d’avoir des résultats satisfaisants après deux mois de suivi post-opératoire.

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Figures

Fig. 1
Fig. 1
Case 4: a 27-year-old man with injuries of the lateral collateral ligament and common extensor tendon. a Preoperative plain radiograph. b Post-reduction radiograph. c, d Post-reduction magnetic resonance image showing injuries of the lateral collateral ligament complex (white arrows) with posterolateral subluxation of the radial head (R.H.) from the capitellum (C). e Intraoperative photograph of the lateral epicondyle (L. Epi). Note the complete avulsion of the collateral ligament, common extensor tendon from the lateral epicondyle. f Postoperative radiograph. g, h Photographs at last follow-up
Fig. 2
Fig. 2
Case 5: an 18-year-old judo player. There was a palpable gap between the ruptured flexor tendon ends. a, b Magnetic resonance image showing injuries of the medial collateral ligament, flexor tendon and anterior capsule. Partial tear of the brachialis (white arrow) was noted. c Intraoperative photograph of the medial epicondyle (M. Epi) showing the complete avulsion of the collateral ligament from the medial epicondyle (white arrow) and flexor tendon at musculotendinous junction. The anterior capsule was avulsed from the humeral attachment
Fig. 3
Fig. 3
Case 12: a 40-year-old man with injuries of both medial and lateral structures. a Initial plain radiograph. b Non-congruent ulnohumeral joint after closed reduction (white arrows). c, d Post-reduction magnetic resonance image showing injuries of the medial, lateral collateral ligament complex and anterior capsule with large haematoma (white arrows) in the anterior compartment. e Calcification in the brachialis which limited range of motion during rehabilitation. f, g Plain radiographs at 32 months postoperatively. h Photograph at last follow-up
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