A hinged external fixator for the elbow.
OBJECTIVE
Stabilization of the ulnohumeral joint against rotation and shear forces, preserving flexion and extension movements, in order to safeguard the healing of the collateral ligaments.


METHODS
Persistent instability of the elbow joint in 90 degrees flexion following elbow dislocation, particularly in the anteroposterior direction; dislocation fractures; arthrolysis and graft arthroplasties; closed distraction arthrolysis.


METHODS
Local infection in the area of the planned Schanz pins, uncertain position of the neurovascular structures, and lack of experience with the external fixator.


METHODS
Determination of the joint axis through the capitulum of the humerus and the trochlea. Insertion of a 3-mm Kirschner wire (reference pin) in the center of rotation. Insertion of the humeral and ulnar Schanz pins under direct vision from the lateral or medial aspect. The lateral humeral Schanz pins are inserted in the distal humerus dorsal to the radial nerve. Removal of the reference pin. Symmetrical distraction of the ulna 2-3 mm from the joint surface of the humerus with the aid of the distractor.


METHODS
No immobilization, immediate start on active and passive physiotherapy under plexus anesthesia, depending on the soft-tissue situation, individual pain, and the extent of the surgical procedure.


RESULTS
The case histories of ten patients treated for persistent instability of the elbow at 90 degrees flexion or for an old dislocation of the elbow between April 2001 and March 2003 were studied retrospectively. The average age was 51 years (40-62 years). In seven patients internal fixation of the elbow had to be performed, six of which were treated initially with an AO fixator. After an average of 8 days the management was changed to hinged fixation. The median Mayo Elbow Function Score was 78 points with two very good, three good, and five satisfactory results. Subjective satisfaction on the DASH Score (Disabilities of Arm, Shoulder and Hand) revealed a slight reduction by an average of 18 points.
Klinik für Unfallchirurgie, Friedrich-Schiller-Universität Jena. wkolb@med.uni-jena.de
Werner
W
Kolb
Hanno
H
Guhlmann
Eberhard
E
Markgraf
Klaus
K
Kolb
D000328:Adult; D001858:Bone Nails; D001864:Bone Wires; D004551:Elbow Joint / Q000502:physiology / Q000601:surgery*; D016267:External Fixators; D005260:Female; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D004204:Joint Dislocations / Q000150:complications; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries