Additional external hinged fixator after open repositioning and internal fixation of acute elbow instability in non-compliant patients

Abstract

This is a retrospective analysis of the clinical and radiological outcome in 11 patients with complex acute posttraumatic elbow instability after dislocation. These patients had also been treated with a hinged external fixator after open reduction, capsular and ligamentous reconstruction and internal fixation, because of an expected diminished compliance, to avoid a secondary dislocation of the internal fixation. Concentric stability and a sufficient range of motion of the elbow joint were achieved in all cases. Non-compliant patients were classified by the surgeon as not compliant or not able or not willing to cooperate post-operatively for various reasons, such as alcoholism, drug abuse, mental disability, cerebral trauma or senile dementia. Non-compliant patients had undergone open reduction and internal fixation of an acute posttraumatic unstable elbow. The addition of a hinged external fixator allows early intensive mobilization, and can protect and improve the clinical outcome after these complex elbow injuries. This evaluation remains, of course, largely subjective and decision making is not easy because in most cases, the patient was not known before surgery. Thus, the only patient exclusion criteria in this study was surgeon classification as "compliant".

Keywords: elbow; fracture dislocation.; hinged external fixator; instability; trauma.

Figure 1

Pre- and post-operative clinical course of a fracture-dislocation: first X-rays after the accident, after reposition/cast, after application of the external fixator with radial head removement, and twelve weeks after the accident.

Figure 2

Pictures after the application of external fixator.