title: Treatment of chronically unreduced complex dislocations of the elbow.
abstract: Chronic dislocation of the elbow is an exceedingly disabling condition associated with severe instability, limitation of elbow function and significant pain. Due to the potentially conflicting goals of restoring elbow stability and regaining a satisfactory arc of motion, successful treatment is a challenge for the experienced trauma surgeon. We report our treatment strategy in three patients suffering from chronically unreduced fracture-dislocations of the elbow. The treatment protocol consists of in situ neurolysis of the ulnar nerve, distraction and reduction of the joint using unilateral hinged external fixation and repair of the osseous stabilizers. A stable elbow was achieved in all patients, without the need of reconstruction of the collateral ligaments. At final follow-up, the average extension/flexion arc of motion was 107 degrees (range, from 100 degrees to 110 degrees ). The average MEPI score at follow-up was 93, and the average DASH score was 19. This is a promising treatment protocol for the treatment of chronically unreduced complex elbow dislocations to restore elbow stability and regain an excellent functional outcome.
authors.affiliation: Department of Orthopaedic Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany, roland.ivo@uk-koeln.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Ivo
authors.forename: Konrad
authors.initials: K
authors.lastname: Mader
authors.forename: Jens
authors.initials: J
authors.lastname: Dargel
authors.forename: Dietmar
authors.initials: D
authors.lastname: Pennig
references.citation: Clin Orthop Relat Res. 2005 Feb;(431):21-5
references.pmid: 15685051
references.citation: Am J Ind Med. 1996 Jun;29(6):602-8
references.pmid: 8773720
references.citation: J Shoulder Elbow Surg. 2000 Jul-Aug;9(4):344-6
references.pmid: 10979534
references.citation: Injury. 1976 Aug;8(1):39-42
references.pmid: 1002274
references.citation: J Bone Joint Surg Am. 2007 Mar;89 Suppl 2 Pt.1:26-35
references.pmid: 17332123
references.citation: J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):101-4
references.pmid: 14735084
references.citation: J Bone Joint Surg Br. 2005 Feb;87(2):191-5
references.pmid: 15736741
references.citation: J Bone Joint Surg Br. 1998 May;80(3):490-2
references.pmid: 9619943
references.citation: Hand Clin. 2008 Feb;24(1):91-103
references.pmid: 18299023
references.citation: Instr Course Lect. 2003;52:113-34
references.pmid: 12690844
references.citation: J Bone Joint Surg Am. 1984 Jul;66(6):921-6
references.pmid: 6736092
references.citation: J Trauma. 1993 Dec;35(6):962-5
references.pmid: 8264002
references.citation: J Bone Joint Surg Am. 2002 Sep;84(9):1630-5
references.pmid: 12208921
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1984;70(4):305-12
references.pmid: 6236495
references.citation: J Vasc Surg. 1992 Sep;16(3):402-6
references.pmid: 1522643
references.citation: J Bone Joint Surg Br. 1982;64(5):603-6
references.pmid: 7142268
references.citation: J Shoulder Elbow Surg. 2005 Sep-Oct;14(5):549-53
references.pmid: 16194750
references.citation: J Trauma. 1979 Mar;19(3):186-8
references.pmid: 458885
references.citation: J Bone Joint Surg Br. 1987 Mar;69(2):199-202
references.pmid: 3546327
references.citation: JAMA. 1965 Dec 13;194(11):1171-6
references.pmid: 4284719
references.citation: Chir Main. 2007 Jun;26(3):150-3
references.pmid: 17596986
references.citation: Injury. 2001 Dec;32 Suppl 4:SD70-8
references.pmid: 11812479
references.citation: J Bone Joint Surg Am. 1992 Apr;74(4):479-90
references.pmid: 1583042
references.citation: J Shoulder Elbow Surg. 2007 Sep-Oct;16(5):e1-4
references.pmid: 17321156
references.citation: Emerg Med J. 2005 Sep;22(9):667-9
references.pmid: 16113198
references.citation: J Hand Surg Am. 2004 May;29(3):470-80
references.pmid: 15140492
references.citation: J Natl Med Assoc. 1974 Nov;66(6):465-7, 471
references.pmid: 4436876
references.citation: Injury. 2000;31 Suppl 1:35-44
references.pmid: 10717272
references.citation: J Bone Joint Surg Am. 1989 Oct;71(9):1348-54
references.pmid: 2793888
references.citation: Orthop Clin North Am. 2008 Apr;39(2):155-61, v
references.pmid: 18374806
references.citation: Clin Orthop Relat Res. 1980 May;(148):254-5
references.pmid: 7379402
references.citation: Singapore Med J. 2004 Jan;45(1):14-9
references.pmid: 14976577
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1990;76(5):303-10
references.pmid: 2148411