title: Posterior approach for surgical treatment of neglected elbow dislocation.
abstract: BACKGROUND
  Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach.
  
  
  METHODS
  This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required.
  
  
  RESULTS
  The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection.
  
  
  CONCLUSIONS
  Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedics and Traumatology, Aristide-Le-Dantec Teaching Hospital Center, BP 5994, Dakar, Senegal. nfcoulibaly@hotmail.com
authors.forename: N F
authors.initials: NF
authors.lastname: Coulibaly
authors.forename: H
authors.initials: H
authors.lastname: Tiemdjo
authors.forename: A D
authors.initials: AD
authors.lastname: Sane
authors.forename: Y F
authors.initials: YF
authors.lastname: Sarr
authors.forename: A
authors.initials: A
authors.lastname: Ndiaye
authors.forename: S
authors.initials: S
authors.lastname: Seye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult