title: Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation.
abstract: BACKGROUND
  Long-term results after the treatment of fracture-dislocations of the elbow have often been disappointing, because of post-traumatic instability, stiffness, and early arthritis. We present the results after surgical restoration of stability in complex fracture-dislocations of the elbow using early postoperative mobilization with a hinged external fixator after internal reconstruction of the static stabilizers.
  
  
  METHODS
  Twenty patients with persistent instability after fracture-dislocation of the elbow were treated at a mean of 11 weeks after injury. We evaluated 17 elbows in 16 patients (mean age, 44 years) at a mean of 44 months after the definitive surgical procedure.
  
  
  RESULTS
  Overall, 10 of 17 elbows had a good or excellent result. The mean range of motion was 96° (SD, 23°). The mean Mayo Elbow Performance Score (MEPS) was 74 (SD, 18), and the mean Functional Elbow Score was 68 (SD, 21). Patients treated within 6 weeks after the trauma had significantly better scores, with a mean MEPS of 81 (SD, 18), than patients treated after a delay, with a mean MEPS of 62 (SD, 13). No patients had recurrent dislocation. Secondary arthritis was mainly found in the delayed-treatment group. Of 17 elbows, 7 (41%) had complications.
  
  
  CONCLUSIONS
  Surgical restoration of the static stabilizers in combination with hinged external fixation leads to satisfactory results when performed within the first 6 weeks after injury. When definite surgical stabilization is delayed more than 6 weeks, the procedure can still restore stability but the functional results are often disappointing.
authors: Shoulder and Elbow Section, Orthopedic Department T, Herlev Hospital, Copenhagen University, Herlev, Denmark. belling@dadlnet.dk
authors: Anne Kathrine B
authors: AK
authors: Sørensen
authors: Jens Ole
authors: JO
authors: Søjbjerg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004550:Elbow / Q000503:physiopathology / Q000601:surgery; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries