gms | German Medical Science

Objectives/Interrogation: Neglected posterior dislocation of the elbow is common in developing countries. Neglected posterior dislocations often present with myositis ossificans from massage and treatment from bone-setters in developing countries. Such problems in young, active patients present a challenging problem to the upper extremity surgeon. Pain and loss of motion associated with elbow stiffness is poorly tolerated and constitutes a major functional impairment.

Methods: We evaluated the clinical results of open reduction and fascia lata interposition arthroplasty in patients with neglected posterior dislocation of the elbow of more than 1 year duration associated with myositis ossificans,focusing on range of motion,stability & pain. All patients underwent open reduction, contracture release, triceps plasty,fascia lata interposition arthroplasty with a hinge elbow fixator distractor and collateral ligament reconstruction.

Results and Conclusions: 11 patients (all males) were treated for neglected dislocation of the elbow between Jan 2009 and Dec 2015 at our Institute. Mean time from injury was 15.7 months(range, 12-24 months). The mean period of follow-up was 29.33 months (range, 14-48 months). All patients had satisfactory pain relief. 8 out of11 (72.7%) patients had an excellent or good result by the objective criteria of the Mayo Elbow Performance score. 2 patients had fair outcomes. In 1 patient instability of the elbow, both before and after surgery, was found to be associated with an unsatisfactory result.

Interposition arthroplasty, combined with hinged external fixation, is a viable solution for neglected posterior dislocations of the elbow in young active individuals in developing countries. The use of a fascia lata graft provides a stable and adequate interposition material without overstuffing the joint. Our mid and long term results are encouraging and we feel that this is a viable and robust non-prosthetic arthroplasty option in carefully selected patients.