Improved Understanding of Traumatic Complex Elbow Instability

Abstract

Recent advancements in surgical treatment have improved clinical results in complex traumatic elbow injury. There is increasing recognition that conservative treatment and inadequate surgical fixation carry high risk of substantial morbidity in many of these cases. Recent literature displays improved outcomes in complex elbow instability, in part, because of a more complete comprehension of the injury patterns and fixation methods. Prompt surgical management with stable internal fixation, which permits immediate postoperative mobilization, has been a consistent variable across the reports leading to more satisfactory outcomes. This applies to both acute and chronic cases.

Figure 1

Radiology images (A) and CT scan (B) demonstrating transolecranon fracture-dislocation of the elbow. Radiographs demonstrating surgical fixation using a proximal ulna plate and screws (C).

Figure 2

Postreduction CT scans demonstrating terrible triad injury of the elbow with radial head and coronoid fracture (A). Radiographs demonstrating surgical fixation using a radial head prosthesis (B).

Figure 3

Three-dimensional CT scan (A) and radiology image (B) demonstrating anteromedial coronoid fracture. Radiographs demonstrating surgical fixation using a coronoid plate and repair of the lateral collateral ligament (C).

Figure 4

Case 1: Magnetic resonance image (A) and fluoroscopy image (B) demonstrating gross instability of the elbow with medial and lateral joint widening. Radiographs demonstrating surgical treatment using an internal joint stabilizer to provide stability and maintain a concentric joint (C). Twelve-month follow-up radiographs showing a reduced and stable joint (D).

Figure 5

Case 2: Fluoroscopy images demonstrating transolecranon fracture-dislocation (A). Radiographs demonstrating surgical fixation using a proximal ulna plate and internal joint stabilizer (B). Three-year follow-up radiographs demonstrating that the elbow was stable and the patient had satisfactory function (C).

Figure 6

Case 3: Radiology images at the time of injury (A and B) and after four weeks (C and D) demonstrating fracture of the anteromedial facet of the coronoid and incomplete fracture of the radial neck.

Figure 7

Case 3: Intraoperative image demonstrating fracture of the anteromedial facet of the coronoid under applied varus stress (A). Postoperative radiology images after plate and screw fixation of the coronoid fracture (B and C). Clinical images at eight weeks demonstrating elbow flexion and extension (D).