Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation.

Abstract

Long-term results after the treatment of fracture-dislocations of the elbow have often been disappointing, because of post-traumatic instability, stiffness, and early arthritis. We present the results after surgical restoration of stability in complex fracture-dislocations of the elbow using early postoperative mobilization with a hinged external fixator after internal reconstruction of the static stabilizers. Twenty patients with persistent instability after fracture-dislocation of the elbow were treated at a mean of 11 weeks after injury. We evaluated 17 elbows in 16 patients (mean age, 44 years) at a mean of 44 months after the definitive surgical procedure. Overall, 10 of 17 elbows had a good or excellent result. The mean range of motion was 96° (SD, 23°). The mean Mayo Elbow Performance Score (MEPS) was 74 (SD, 18), and the mean Functional Elbow Score was 68 (SD, 21). Patients treated within 6 weeks after the trauma had significantly better scores, with a mean MEPS of 81 (SD, 18), than patients treated after a delay, with a mean MEPS of 62 (SD, 13). No patients had recurrent dislocation. Secondary arthritis was mainly found in the delayed-treatment group. Of 17 elbows, 7 (41%) had complications. Surgical restoration of the static stabilizers in combination with hinged external fixation leads to satisfactory results when performed within the first 6 weeks after injury. When definite surgical stabilization is delayed more than 6 weeks, the procedure can still restore stability but the functional results are often disappointing.