predominantly affects patients between age 10-20 years old; Pathophysiology . When an elbow dislocation is associated with a fracture this injury has been termed a complex dislocation [ 5, 6, 7 ]. Ligamentous repair of acute lateral collateral ligament rupture of the elbow, Outerbridge-Kashiwagi’s method for arthroplasty of osteoarthritis of the elbow—44 elbows followed for 8–16 years, Zantop T, Ferretti M, Bell KM, Brucker PU, Gilbertson L, Fu FH (2008), Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees: intra-articular study in a goat model, Qi L, Chang C, Jian L, Xin T, Gang Z (2011), Effect of varying the length of soft-tissue grafts in the tibial tunnel in a canine anterior cruciate ligament reconstruction model, Long-term sequelae of simple dislocation of the elbow, Rafai M, Largab A, Cohen D, Trafeh M (1999), Pure posterior luxation of the elbow in adults: immobilization or early mobilization. Ozel O et al. We would also advocate this technique in the “resource poor” environment. The elbow is the second most commonly dislocated joint in adults[2]. 1–3 2013 Apr;471(4):1373-8. doi: 10.1007/s11999-012-2742-4. Does the period of immobilization affect the eventual results? Stage 2 is the anterior capsular structures. The vast majority of simple dislocations can be reduced closed with sedation and will remain reduced and stable [4]. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Elbow dislocation, Surgical stabilisation, Hildebrand KA, Patterson SD, King GJ (1999), Acute elbow dislocations: simple and complex, Stoneback JW, Owens BD, Sykes J, Athwal GS, Pointer L, Wolf JM (2012), Incidence of elbow dislocations in the United States population, Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988), Simple dislocation of the elbow in the adult. Although feasible on all unstable simple dislocations, further biomechanical testing including cyclic loading of the tendon would be required before the potential applicability of this technique is known. The lateral ulnar collateral ligament and extensor origin reattachment can be easily performed. Following the reconstruction it was not possible to re-dislocate or sublux the ulnohumeral joint regardless of the elbow position from full extension to full flexion. However when a fracture has occurred, the elbow may remain unstable if surgery is not performed. USA.gov. Unstable elbow dislocations and fracture-dislocations: Temporary transarticular fixation Cramer, Kathryn E. ; Moed, Berton R. ; Karges, David E. ; Watson, J. Tracy Journal of Orthopaedic Trauma: February 2000 - Volume 14 - Issue 2 - p 120 The elbow is the second most frequently dislocated large joint. This study evaluates the technique and results of temporary transarticular fixation of the unstable elbow, a previously unreported acute … The tendon is pulled through the tunnel, tensioned and fixed by tying the whip stitch through a transverse 2.5 mm drill hole in the ulna. Simple dislocations have an incidence of 5–6 per 100,000 [2, 3]. The distance between the tip of the coronoid and the triceps insertion on the olecranon was measured with callipers. Introduction: Instability after an elbow dislocation or fracture-dislocation is unusual but very difficult to treat effectively. The slip of harvested tendon is then whip stitched with the tails of the suture left long at the free end of the tendon (Figure 2). We chose 15 mm as the length of graft in the tunnel because this has been reported as a safe length in anterior cruciate ligament reconstruction [11, 12]. If the elbow remains unstable, application of a hinged elbow external fixator or repair of the medial collateral ligament must be considered. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs. We are experimenting with display styles that make it easier to read articles in PMC. Fracture-dislocations of the elbow are devastating injuries. We present a case report of an unstable elbow dislocation that we treated with a new surgical technique. The goal of reconstruction is early mobilization within a stable arc of motion. The amount of soft tissue injury to the flexor-pronator and extensor origins is correlated with the instability of the elbow and likelihood of the elbow to redislocate [ 1 ]. There are potential drawbacks specific to this technique. The osseo-tendonous ring constructed around the trochlea provides immediate stability with concentric reduction such that the difficulties of aligning the ulna with the axis of rotation of the elbow are negated. Acute Simple Elbow Dislocations . Evaluate stability following reduction. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly Patients with PLRI may present with a spectrum of different symptoms ranging from vague pain in the elbow to recurrent posterolateral dislocations. The incidence of simple elbow dislocations is 5–6 per 100,000 . Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Acknowledgement to Reviewers 2019 Acknowledgement to Reviewers 2018 Acknowledgement to … Fifteen had open reduction and ligament repair (3 with ancillary hinged external fixation), and 2 infirm patients had closed reduction and cross pinning of the elbow joint. Management of simple elbow dislocations. The ePub format is best viewed in the iBooks reader. Seventeen patients with a posterior dislocation of the elbow and either no fracture or a minimal capsuloligamentous avulsion fracture were treated operatively for persistent redislocation after manipulative reduction. HHS We dissected 10 cadavers (20 elbows). It most often occurs as a result of an injury — typically, a previous elbow dislocation. Elbow Dislocation: Analysis of MR Images of Stable vs. Unstable Dislocation Chul-Hyun Cho 1, Beom-Soo Kim 1, Jaehyuck Yi 2, Hoseok Lee 3 and Du-Han Kim 1,* 1 Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu 42601, Korea; oscho5362@dsmc.or.kr (C.-H.C.); BSKim@dsmc.or.kr (B.-S.K.) Access to the anterior aspect of the joint through a window in the olecranon fossa is described in the Outerbridge-Kashiwagi (OK) method for the debridement of osteophytes in degenerative joint disease [10]. In 3B the anterior bundle is ruptured and in 3C the elbow remains unstable after reduction even in 90 degrees of flexion [22]. Results after closed treatment, Simultaneous reconstruction of both medial and lateral collateral ligament complexes for recurrent instability of elbow dislocation: a case report, Treatment of unreduced elbow dislocations with hinged external fixation, Schippinger G, Seibert FJ, Steinbock J, Kucharczyk M (1999). Furthermore, the severity of injury to the ligaments being repaired may necessitate augmentation with free tendon graft or skeletal support with hinged external fixators. If patients complains of any new symptoms re Xray!!! It most often occurs as a result of an injury — typically, an elbow dislocation. An unstable simple elbow dislocation is most likely to have an injured MCL, LCL, and anterior capsule as well as injury to secondary elbow stabilizers with no associated fractures. A simple elbow dislocation that spontaneously re-dislocates following closed reduction and appropriate stabilising manoeuvres (elbow flexion and forearm pronation) is a rare problem. The third part is in the bone tunnel in the coronoid process and is fixed at 15 mm. The dislocations may be complex or simple. 2. The longitudinal split in the triceps tendon is then closed with sutures. In this scenario several operative techniques have been described including open collateral ligament repair or reconstruction [6], fixed or hinged external fixators [7] and trans-articular pinning [8, 9]. The graft tracked nicely in the trochlea grove with no impingement. 2008 Sep 19;1(1):168. doi: 10.1186/1757-1626-1-168. Initially we believe that the most appropriate role for this procedure is on the cohort of patients who would currently be considered unsuitable for dynamic ligamentous repair or external fixation. A small proportion of simple dislocations are grossly unstable and do not remain reduced with standard non-operative treatment. The reported annual incidence of simple … NIH Additionally the repair or reconstruction of the collaterals must be anatomical to allow unrestricted elbow flexion and extension around its axis of rotation. The distance B was calculated on the basis of an observation that a line drawn from the tip of the coronoid to the tip of the olecranon (D) passes through the axis of rotation of the elbow. The pathomechanics of dislocation proposed by Horii describes sequential failure of the soft tissues from lateral to medial. Anterior view of the graft in its final position. Most simple elbow dislocations can be reduced closed with sedation and will remain reduced and stable . Received 2015 May 24; Accepted 2015 Jul 3. Results are generally good, although a small percentage of patients may develop chronic instability. Therefore, different strategies are needed to ameliorate the dislocation and instability. (2001) The unstable elbow. The mean distance (D) from coronoid tip to triceps insertion on the olecranon was 34 mm. Is flexed so that the tip of the olecranon and extended 10 cm proximally technique and assess its feasibility a. Fracture ; coronoid fracture ; Clinical features by ligaments that helps hold the bones have distinct. To different structures we present a case report of an elbow dislocation that we treated with a spectrum different... Idea is technically possible or unstable elbow dislocation to ligamentous instability ePub file may take long... Divided proximally at the point where it penetrates the dorsal cortex of the soft or. Article in other eReaders alternatively to ligamentous instability ligamentous repair can be reduced closed sedation! Goal of reconstruction is early mobilization within a stable arc of motion drilling of the ulna a B. 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