title: Hinged elbow fixator: an extracorporeal technique to position the hinge based on an original guidewire device.
abstract: BACKGROUND
  The application of a hinged elbow external fixator is technically demanding because the hinge axis must coincide exactly with the flexion-extension axis of the elbow. The standard technique involves inserting a 3-mm K-wire freehand into the distal humerus to materialize the flexion-extension axis. We designed a guidewire device for extracorporeal hinge positioning without K-wire insertion. In a cadaver study, we compared freehand K-wire insertion and our extracorporeal technique.
  
  
  METHODS
  In 12 cadaveric elbows, we induced acute elbow instability by sectioning the medial collateral ligament complex and the anterior and posterior capsule. A hinged external fixator was applied to each elbow using both techniques. The outcome measures were procedure duration, number of image-intensifier shots (as a measure of radiation exposure), and passive motion range after fixator implantation.
  
  
  RESULTS
  Compared with the freehand K-wire technique, the extracorporeal technique provided greater range of motion and significantly lower values for procedure duration and number of image-intensifier shots. Data dispersion was less marked with the extracorporeal technique, indicating better reproducibility.
  
  
  CONCLUSIONS
  The extracorporeal technique based on a guidewire device enabled non-invasive positioning of a hinged elbow external fixator. This technique was faster, less irradiating, and more reproducible than the freehand K-wire technique.
authors.affiliation: Centre hospitalier de Bicêtre, AP-HP, 94270 Paris, France. m.begin@wanadoo.fr
authors.forename: M
authors.initials: M
authors.lastname: Begin
authors.forename: L
authors.initials: L
authors.lastname: Ruscio
authors.forename: L
authors.initials: L
authors.lastname: Ratte
authors.forename: O
authors.initials: O
authors.lastname: Bartier
authors.forename: O
authors.initials: O
authors.lastname: Gagey
authors.forename: M
authors.initials: M
authors.lastname: Soubeyrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001864:Bone Wires; D002102:Cadaver; D004550:Elbow / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D016267:External Fixators; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: Elbow dislocation; Elbow instability; External fixator; Fixateur externe; Instabilité du coude; Luxation du coude