McKee, J Bone Joint Surg Am 2005 - Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Surgical Technique

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Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Surgical Technique

McKee, King, et al.·J Bone Joint Surg Am·2005·191 citations·Case series

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Background

The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at 7 to 10 days postoperatively and enhance functional outcome.

Methods

We retrospectively reviewed the results of this treatment performed, at 2 university-affiliated teaching hospitals, in 36 consecutive patients (36 elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process.
Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvant-hinged external fixation.
Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up.

Results

At a mean of 34 months postoperatively, the flexion-extension arc of the elbow averaged 112 degrees +/- 11 degrees and forearm rotation averaged 136 degrees +/- 16 degrees .
The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to 15 excellent results, 13 good results, 7 fair results, and one poor result.
Concentric stability was restored to 34 elbows.
8 patients had complications requiring a reoperation: 2 had a synostosis; one, recurrent instability; 4, hardware removal and elbow release; and one, a wound infection.

Conclusions

Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries.

Copyright remains with the authors and publisher.

Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Surgical Technique.

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Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Surgical Technique

McKee, King, et al.·J Bone Joint Surg Am·2005·191 citations·Case series

|

Background

The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at 7 to 10 days postoperatively and enhance functional outcome.

Methods

We retrospectively reviewed the results of this treatment performed, at 2 university-affiliated teaching hospitals, in 36 consecutive patients (36 elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process.
Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvant-hinged external fixation.
Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up.

Results

At a mean of 34 months postoperatively, the flexion-extension arc of the elbow averaged 112 degrees +/- 11 degrees and forearm rotation averaged 136 degrees +/- 16 degrees .
The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to 15 excellent results, 13 good results, 7 fair results, and one poor result.
Concentric stability was restored to 34 elbows.
8 patients had complications requiring a reoperation: 2 had a synostosis; one, recurrent instability; 4, hardware removal and elbow release; and one, a wound infection.

Conclusions

Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries.

Copyright remains with the authors and publisher.

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