Internal Joint Stabilization for Recurrent Nontraumatic Elbow Dislocation in a Skeletally Immature Patient

Abstract

Case: A 14-year-old adolescent boy with SCN1B mutation experienced frequent seizures and recurrent elbow dislocation, occurring up to 30 times per day. Following failed conservative treatment, the decision was made to surgically repair the lateral collateral ligament complex and stabilize the elbow with the internal joint stabilizer (IJS). At more than 3 years postoperatively, the patient has not had a dislocation event and will retain the device for the foreseeable future to maintain predictable elbow stability.

Conclusion: Although there is scant evidence supporting the use of the IJS in pediatric cases, the current case supports its use in pediatric elbow instability.

Fig. 1

Anteroposterior (Fig. 1-A) and lateral (Fig. 1-B) radiography demonstrating incongruous ulnohumeral and radiocapitellar joints in a skeletally immature patient.

Fig. 2

Coronal computed tomography arthrogram demonstrating a wide radiocapitellar joint potentially due to interposed soft tissue which may be displaced lateral collateral ligament complex (Fig. 2-A). Sagittal computed tomography arthrogram demonstrating incongruous ulnohumeral joint and bony remodeling which may be consequential to chronic dislocation events (Fig. 2-B).

Fig. 3

Intraoperative images of capitellar centering (Fig. 3-A) and axis (Fig. 3-B) guides used to place a wire across the elbow center of rotation. Lateral fluoroscopy of the axis guide aligned with the elbow center of rotation within the distal humerus (Fig. 3-C).

Fig. 4

Anteroposterior (Fig. 4-A) and lateral (Fig. 4-B) radiography at 38 months postoperative demonstrating a concentric elbow with the internal joint stabilizer axis pin across the elbow center of rotation, connected through articulating arms to a baseplate fixed to the proximal ulna.