title: Hinged external fixation for Regan-Morrey type I and II fractures and fracture-dislocations.
abstract: Elbow fracture-dislocation is always demanding to manage due to the considerable soft-tissue swelling or damage involved, which can make an early open approach and ligamentous reconstruction impossible. The purpose of this study was to evaluate the role of elbow hinged external fixation (HEF) as a definitive treatment in patients with elbow dislocations associated with Regan-Morrey (R-M) type I and II coronoid fractures and soft-tissue damage. We treated 11 patients between 2010 and 2012 with HEF. Instability tests and standard X-ray examinations were performed before surgery and 1-3 to 3-6 months after surgery, respectively. All patients underwent a preoperative CT scan. Outcomes were assessed with a functional assessment scale (Mayo Elbow Performance Score, MEPS) that included 4 parameters: pain, ROM, stability, and function. The results were good or excellent in all 11 patients, and no patient complained of residual instability. Radiographic examination showed bone metaplasia involving the anterior and medial sides of the joint in 5 patients. HEF presented several advantages: it improves elbow stability and it avoids long and demanding surgery in particular in cases with large soft tissue damage. We therefore consider elbow HEF to be a viable option for treating R-M type I and II fracture-dislocations.
authors.affiliation: Clinica Ortopedica e Traumatologica, Università Degli Studi di Pavia, IRCCS Policlinico San Matteo, Pavia, Italy. albecastell@libero.it.|Clinica Ortopedica e Traumatologica, IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy. albecastell@libero.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Castelli
authors.affiliation: Clinica Ortopedica e Traumatologica, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'amico
authors.affiliation: Clinica Ortopedica e Traumatologica, IRCCS Policlinico San Matteo, Pavia, Italy.|Clinica Ortopedica e Traumatologica, Università Degli Studi di Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Combi
authors.affiliation: Clinica Ortopedica e Traumatologica, Università Degli Studi di Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Benazzo
mesh_terms: D000328:Adult; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D000072039:Fracture Dislocation / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Coronoid; Elbow fracture-dislocation; Heterotopic ossification; Hinged external fixator; Instability