gms | German Medical Science

Objectives: More than two decades ago the transarticular external fixator with motion capacity of the elbow was developed and has since then extensively broadened the therapeutic spectrum in treating complex elbow joint injury. Since 1996, in three consecutive Level- I- Trauma centers, a standardized prospective treatment protocol, the so- called elbow fixator concept was developed. In the last 5 years the use of hinged elbow fixation was questioned claiming high rates of revision due to the uncorrect mounting of the fixator and and high fixator- related complications.

Methods: An extensive prospective computerized database for hinged elbow fixators was created. For all patient, standardized diagnostic, therapeutic, aftercare and patient evaluation tools were used (TROM, Q-DASH, MEPI, 2 Quality of life scores). Using this pathway, during a period of 20 years in three major elbow trauma centers 1225 elbow fixators with motion capacity were included in the treatment concept in adult unstable elbow dislocations (n = 153), fracture dislocations (n= 375), acute or chronic pediatric elbow injury (n= 95), revision after elbow redislocation or fixation failure (n= 203) and posttraumatic stiffness (n = 350). The following parameters were prospectively documented and analyzed: Fixator stay, accuracy of fixator placement (i.e. intraoperative passive TROM), time in fixator, fixator related complications (redislocation, pin- related fractures, pin-site infections), the rate of redislocation of the elbow joint during and after hinged fixation, nerve complications and the overall functional result.

Results and conclusion: Mean fixator stay was 6 weeks (range, 5 to 8 weeks). No fixator was removed preplanned due to fixator- related complications. The mounting of the fixator was with a very high accuracy with a mean intraoperative passive TROM of 100 degrees in 99,5 %. There were 5 fixator related complications (2 sagittal and 3 varus subluxation of the elbow in the postoperative period requiring operative reapplication of the center hinge of the fixator). There were 4 fixator - related fractures in the postoperative period, namely 3 ulnar fractures and 1 humeral fracture due to a fall on the fixator, requiring resiting of the ulnar clamp in 2 and plating of the ulna and the humerus in 1 case each. There were 25 pin-site infections, of which 10 required resiting of fixator pin and 15 resolved by intensive pin site care and antibiotic treatment. There were no complications to the radial nerve and 8 postoperative surgery related ulnar neuropathies (PSRUN) in the severe posttraumatic elbow stiffness group, requiring in situ neurolysis of the ulnar nerve. The overall functional result was excellent. Hinged elbow fixations is a safe, reliable and versatile surgical tool in complex elbow trauma and posttraumatic elbow reconstruction with a very low fixator- related complication rate in specialized elbow centers with elaborated teaching programs and a functioning aftercare unit but may belong in these centers.