Reconstruction for persistent instability of the elbow after coronoid fracture-dislocation.
The results of reconstruction for chronic instability after coronoid fracture have not been previously described. Patients with persistent instability after coronoid fracture-dislocation were assessed after reconstruction. A satisfactory outcome was considered to be present based on the Mayo Elbow Performance Score and on the patient's willingness to repeat the operation. The length of follow-up was a minimum of 2 years, averaging over 5 years. Overall, 13 of 21 patients (62%) were classified as having a successful outcome objectively, and 17 of 21 (81%) were classified as having a successful outcome subjectively. The duration of the delay to definitive treatment was closely associated with the ultimate outcome (P < .01), as the outcome of only 1 of 7 elbows with a delay greater than 7 weeks was classified as an objective success. Of the patients, 19 had a fractured radial head, 11 of which were initially treated with a radial head excision; none was subsequently reconstructed. Sixteen patients were treated with a hinged external fixator. Of the elbows, 13 remained reduced whereas 8 had variable amounts of anterior or posterior instability. Two failures were ultimately reconstructed with a total elbow arthroplasty. Instability that persists after the initial unsuccessful management of a coronoid fracture and an elbow dislocation is a difficult problem to salvage with subsequent reconstruction. This experience emphasizes the need for better reconstructive options and especially underscores the need for appropriate initial management of this difficult injury.
Papandrea
Rick F
RF
Orthopedic Associates of Wisconsin, Waukesha, WI, USA.
Morrey
Bernard F
BF
O'Driscoll
Shawn W
SW
D000328:Adult; D000368:Aged; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications*; D007593:Joint Instability / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000092464:Elbow Injuries