gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2021)

26. - 29.10.2021, Berlin

Complications and range of motion of patients with an elbow dislocation treated with a hinged external fixator

Meeting Abstract

  • presenting/speaker Dennis Den Hartog - Erasmus MC, Univerity Medical Center Rotterdam, Rotterdam, The Netherlands, Rotterdam, Netherlands
  • Bart Van Tunen - Erasmus MC, Univerity Medical Center Rotterdam, Rotterdam, The Netherlands, Rotterdam, Netherlands
  • Esther M. M. Van Lieshout - Erasmus MC, Univerity Medical Center Rotterdam, Rotterdam, The Netherlands, Rotterdam, Netherlands

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2021). Berlin, 26.-29.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocAB39-1284

doi: 10.3205/21dkou209, urn:nbn:de:0183-21dkou2098

Published: October 26, 2021

© 2021 Den Hartog et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Both simple and complex elbow dislocations are at risk for persistent instability. A common late complication is stiffness of the elbow joint. Treatment with a hinged external fixation for persistent instability of elbow dislocations provides elbow joint stability, and allows early mobilization to prevent stiffness. The use of a hinged elbow fixator is a technically challenging procedure. A high overall rate of fixator-related complications has been reported. The low incidence rate of elbow dislocations with persistent instability suggests that centralization would result in higher surgeon exposure and consequently in less complications. This study aimed to investigate the results of treatment by a dedicated elbow surgeon on the rate of complications and range of motion.

Methods: A single-center retrospective observational cohort study in a level I trauma center and tertiary referral hospital, was performed. All patients of 16 years or older treated with a hinged external elbow fixator between January 1, 2006 and December 31, 2017 were included. The hinged elbow fixator could be used 1) for the treatment of persistent instability in acute/residual simple and complex dislocations or 2) as revision surgery to treat joint incongruency or a stiff elbow. Patient and injury characteristics, details on treatment, complications, secondary interventions, and range of motion were extracted from the patients' medical files.

Results and Conclusion: A total number of 34 patients were analyzed with a median follow-up of 13 months. Twenty four (71%) of these were treated for acute elbow instability and 10 were treated for instability after revision surgery. The fixator was removed after a median period of 48 days. Fixator-related complications encountered were six pintract infections, one redisclocation, one joint incongruency, one muscle hernia, and one hardware failure. The median range of motion at the end of follow-up was 140° flexion, 15° constraint in extension, 90° pronation and 80° supination.

A hinged elbow fixator, applied for elbow instability by a dedicated elbow surgeon results in excellent function. Fixator-related complications were mostly mild and only had temporary consequences. The superior results in the current study, which contains one of the largest cohorts to date to report range of motion in this patient cohort, suggest that surgeon experience may have contributed to a lower complication rate. Based on this, results may benefit from centralizing the treatment of unstable elbow dislocations.