Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 18;4(2):196-203.
doi: 10.1016/j.xrrt.2023.12.004. eCollection 2024 May.

Comparing internal and external stabilization for traumatic elbow instability: a systematic review

John J Heifner  1 , Ty A Davis  2 , Robert J Rowland  2 , Osmanny Gomez  2 , Robert R L Gray  3
Affiliations

Comparing internal and external stabilization for traumatic elbow instability: a systematic review

John J Heifner et al. JSES Rev Rep Tech. .

Abstract

Background: Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS.

Methods: A database query was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Population, Intervention, Comparison and Outcome characteristics for eligibility were the following: for patients over 18 years clinical outcomes were compared between an ExFix or the IJS for acute or chronic elbow instability. The Cochran risk of bias in nonrandomized studies of interventions and grades of recommendation, assessment, development, and evaluation framework were compiled for risk of bias and quality assessment.

Results: The rate of recurrent instability was 4.1% in the IJS group (N = 171) and 7.0% in the ExFix group (N = 435), with an odds ratio of 1.93 (95% confidence interval 0.88-4.23). The rate of device failure was 4.4% in the IJS group and 4.1% in the ExFix group. Pin-related complications occurred in 14.6% of ExFix cases. Complications in the IJS group were the following: 1 case of inflammatory reaction, 4 cases of post removal surgical site infection, and 5 symptomatic removals.

Discussion: The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. Although not statistically significant, the higher rate of recurrent instability following external fixation may be clinically important. The high rate of pin-related complications with external fixation is notable.

Keywords: Elbow instability; External fixation; Hinged external fixator; Internal joint stabilizer; Persistent instability; Pin-tract infection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart sequence of the database query and study selection including stratification of parameters for exclusion.
See this image and copyright information in PMC

References

    1. AlQahtani S., Aibinder W.R., Parry J.A., Seltser A., Athwal G.S., King G.J.W., et al. Static and dynamic external fixation are equally effective for unstable elbow fracture-dislocations. J Orthop Trauma. 2021;35:e82–e88. doi: 10.1097/bot.0000000000001876. - DOI - PubMed
    1. Catapano M., Pupic N., Multani I., Wasserstein D., Henry P. Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review. Shoulder Elbow. 2022;14:211–221. doi: 10.1177/1758573220957631. - DOI - PMC - PubMed
    1. Cheung E.V., O'Driscoll S.W., Morrey B.F. Complications of hinged external fixators of the elbow. J Shoulder Elbow Surg. 2008;17:447–453. doi: 10.1016/j.jse.2007.10.006. - DOI - PubMed
    1. Cui H.M., Yu Y.L., He Y., Cheng Y., Liu J.Z., Zheng W., et al. Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. Int Orthop. 2018;42:609–618. doi: 10.1007/s00264-017-3721-x. - DOI - PubMed
    1. Edelman D., Ilyas A.M. Temporary bridge plate stabilization of unstable elbow fractures and dislocations. Tech Hand Up Extrem Surg. 2018;22:46–50. doi: 10.1097/bth.0000000000000191. - DOI - PubMed

LinkOut - more resources