Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results

Abstract

Objectives: To describe the surgical treatment and patient outcomes of chronic elbow dislocations.

Design: Retrospective review.

Setting: Two tertiary referral centers.

Patients/participants: All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015.

Intervention: Review of patient demographics, injury chronicity, surgical technique, and patient outcomes.

Main outcome measurement: Clinical outcomes included elbow range of motion and complications. Radiographic outcomes included the presence of heterotopic ossification. Patient-reported outcomes included the Mayo Elbow Performance Index (MEPI) and the Summary Outcome Determination (SOD).

Results: Thirty-two patients with mean follow-up of 22 months (range, 13-41 months) were included. The mean dislocation duration was 6 months (range, 1-34 months). The mean preoperative range of motion was 8 degrees (range, 0-30 degrees). There were no infections or recurrent dislocations. One patient developed transient ulnar nerve palsy postoperatively. There were no cases of new or progressive heterotopic ossification. The mean postoperative extension was 31 degrees (range, 0-75 degrees), and the mean postoperative flexion was 132 degrees (range, 95-150 degrees); the mean final arc of motion was 101 degrees (range, 50-140 degrees). The mean postoperative MEPI was 93 (range, 70-100), and the mean SOD score was 9 (range, 6-10). Using the MEPI, 97% (31/32 patients) had good or excellent outcome. There was no difference in flexion/extension arc or MEPI scores between groups of elbows older and younger than 17 years or dislocations less or more than 3 months.

Conclusion: This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

FIGURE 1.

Photograph of lateral exposure of radial head/capitellum with development of anterior and posterior sleeves. Scar is debrided from the radiocapitellar joint through this exposure to allow reduction of the joint. Editor's Note: A color image accompanies the online version of this article.

FIGURE 2.

Drawing of lateral dissection with anterior and posterior sleeves illustrated with relevant anatomy. The dashed blue line illustrates the division of anterior and posterior sleeves on the lateral side, which is directed toward the radial head distally but not distal to the head and directed proximally along the supracondylar ridge. Inset image shows underlying bony anatomy. Editor's Note: A color image accompanies the online version of this article.

FIGURE 3.

Photograph with arm in abduction and external rotation with medial exposure of humeral/olecranon demonstrating development of anterior and posterior soft tissue sleeves (Fig. 5B). Editor's Note: A color image accompanies the online version of this article.

FIGURE 4.

Drawing of medial dissection with anterior and posterior sleeves illustrated with relevant anatomy. The dashed blue line illustrates the division of anterior and posterior sleeves in line with the ulnar nerve, which is initially mobilized with the posterior sleeve before being dissected free for anterior transposition. Inset image shows underlying bony anatomy. Editor's Note: A color image accompanies the online version of this article.

FIGURE 5.

Photograph shows the complete soft tissue release of the “naked” distal humerus presenting through the medial incision and ulnar nerve freed. Editor's Note: A color image accompanies the online version of this article.