J Korean Fract Soc.  2015 Jul;28(3):169-177. 10.12671/jkfs.2015.28.3.169.

Additional Hinged External Fixation in Complex Elbow Injury

• Lee TJ
• Hong TH
• Kim NC

• KMID: 2184412
• DOI: http://doi.org/10.12671/jkfs.2015.28.3.169

Abstract

PURPOSE
The purpose of this study was to evaluate the use of hinged external fixation in management of complex elbow injury.
MATERIALS AND METHODS
We retrospectively reviewed clinical outcomes in 10 patients with elbow dislocation and associated fractures of both the radial head and the coronoid process from January 2007 to December 2013. All ten patients were treated by hinged external fixation after open reduction and internal fixation. The indication for use of a hinged external fixator was persistent instability after fixation of the fractures. Early mobilization was started at 1 week (6.5 days) after surgery. The external fixator was removed at 6 weeks after surgery. Cassebaum classification and Mayo elbow performance score were used for clinical and functional evaluation. The follow-up period was at least 1 year.
RESULTS
At the last follow-up, the average further flexion was 127degrees, and the average flexion contracture was 16degrees. The average pronation was 83degrees and the average supination was 78degrees. By the Cassebaum classification after 1 year follow-up, patients were classified as 4 excellent, 4 good, and 2 poor. According to the Mayo elbow performance score, the average score was 87 points (65-100 points) with 3 excellent, 6 good, and 1 fair. Stability was restored in all patients at the last follow-up. There was no case of nonunion and the average union period was 11.5 weeks.
CONCLUSION
This study advocated the additional use of a hinged external fixator in the treatment of complex elbow instability, especially when fixation of fractures and repair of soft tissues were not sufficient. Providing adequate stability and allowing early motion, additional external fixation could improve the functional outcome.

Keyword

Elbow; Terrible triad; External fixator

MeSH Terms

Classification
Contracture
Dislocations
Early Ambulation
Elbow*
External Fixators
Follow-Up Studies
Head
Humans
Pronation
Retrospective Studies
Supination

Figure

• 

  Fig. 1 A 33-year-old male, initial radiographs and computed tomography showed fracture of the radial head, coronoid process and olecranon process of ulna, and elbow dislocation. Postoperative radiographs show resection arthroplasty for radial head fracture, circlage wiringfor coronoid process fracture, and tension band wiring for olecranon process fractures and hinged external fixation for elbow instability. (A) Preoperative elbow anteroposterior (AP) image. (B) Preoperative elbow lateral image. (C) Preoperative 3-dimensional computed tomography image. (D) Postoperative elbow AP image. (E) Postoperative elbow lateral image.

• 

  Fig. 2 A 65-year-old male, initial radiographs and computed tomography showed fracture of the radial head, coronoid process and elbow dislocation. Postoperative radiographs show fragment resection for the radial head fracture, screw fixation for coronoid process fracture, and hinged external fixation for elbow instability. (A) Preoperative elbow anteroposterior (AP) image. (B) Preoperative elbow lateral image. (C) Preoperative 3-dimensional elbow computed tomography image. (D) Postoperative elbow AP image. (E) Postoperative elbow lateral image.

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  Fig. 3 (A) Postoperative photo with hinged external fixator. (B) After removal of a rod of the external fixator and loosening the hinge, patients started elbow joint movement. One week after surgery.

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