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. 2019 Nov 8;14(1):347.
doi: 10.1186/s13018-019-1374-8.

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Lei Zhang  1   2 , Laixu Wang  2 , Shiyang Yu  3 , Zhanhui Lv  2 , Peng Zhang  1 , Cunyi Fan  4 , Yixin Shen  5
Affiliations

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Lei Zhang et al. J Orthop Surg Res. .

Abstract

Background: The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation.

Methods: Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: The median follow-up was 37.3 months (range, 15-53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up.

Conclusions: Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

Keywords: Elbow; Flexor-pronator tendon; Instability; Medial collateral ligament; Radial head; Valgus.

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Conflict of interest statement

Not applicable. No conflict of interest exists in the submission of this manuscript, and the manuscript is approved by all authors for publication.

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Radial head fractures with avulsion of the medial collateral ligament leading to gross valgus instability of the elbow
Fig. 2
Fig. 2
Anteroposterior (a) and lateral (b) radiographs of the injured elbow. The fracture fragment of the radial head (red arrow) is remarkably displaced. A free bone fragment is found on the medial side of the elbow (yellow arrow). The valgus stress radiograph of the injured elbow (c) demonstrates medial joint space widening (green arrow)
Fig. 3
Fig. 3
T2-weighted coronal image from magnetic resonance imaging. The medial collateral ligament (red arrow) is avulsed from its humeral footprint. The flexor-pronator tendon is torn as well (green arrow). There is an increased signal in their origin on the medial epicondyle. The lateral collateral ligament (yellow arrow) and the lateral ulnar collateral ligament (blue arrow) are intact
Fig. 4
Fig. 4
Intraoperative photographs show anatomical reduction and internal fixation of the type II radial head fracture
Fig. 5
Fig. 5
Intraoperative photograph shows the denuded medial epicondyle, the torn anterior capsule, and the avulsed medial collateral ligament and flexor-pronator tendon. The ulnohumeral joint is visualized deep to the injured structures
Fig. 6
Fig. 6
The medial stabilizers are repaired with suture anchor and nonabsorbable sutures
See this image and copyright information in PMC

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References

    1. Karbach LE, Elfar J. Elbow instability: anatomy, biomechanics, diagnostic maneuvers, and testing. J Hand Surg Am. 2017;42(2):118–126. doi: 10.1016/j.jhsa.2016.11.025. - DOI - PMC - PubMed
    1. Ahmed I, Mistry J. The management of acute and chronic elbow instability. Orthop Clin North Am. 2015;46(2):271–280. doi: 10.1016/j.ocl.2014.11.008. - DOI - PubMed
    1. Safran MR, Baillargeon D. Soft-tissue stabilizers of the elbow. J Shoulder Elbow Surg. 2005;14(1 Suppl S):179S–185S. doi: 10.1016/j.jse.2004.09.032. - DOI - PubMed
    1. Maripuri SN, Debnath UK, Rao P, Mohanty K. Simple elbow dislocation among adults: a comparative study of two different methods of treatment. Injury. 2007;38:1254–1258. doi: 10.1016/j.injury.2007.02.040. - DOI - PubMed
    1. Charalambous CP, Stanley JK, Siddique I, Powell E, Ramamurthy C, Gagey O. Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers. Injury. 2006;37:849–853. doi: 10.1016/j.injury.2006.04.125. - DOI - PubMed