Additional Hinged External Fixation in Complex Elbow Injury

Tong-Joo Lee; Taek Ho Hong; Nak Chul Kim

doi:10.12671/jkfs.2015.28.3.169

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Lee, Hong, and Kim: Additional Hinged External Fixation in Complex Elbow Injury

Original Article

Journal of the Korean Fracture Society 2015; 28(3): 169-177.

Published online: 22 July 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.3.169

Additional Hinged External Fixation in Complex Elbow Injury

Tong-Joo Lee, M.D., Ph.D., Taek Ho Hong, M.D., Nak Chul Kim, M.D.

Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea.

Address reprint requests to: Tong-Joo Lee, M.D., Ph.D. Department of Orthopedic Surgery, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890-3043, Fax: 82-32-890-3047, TJLEE@inha.ac.kr

Received 11 January 2015 Revised 8 April 2015 Accepted 19 May 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the use of hinged external fixation in management of complex elbow injury.

Materials and Methods

We retrospectively reviewed clinical outcomes in 10 patients with elbow dislocation and associated fractures of both the radial head and the coronoid process from January 2007 to December 2013. All ten patients were treated by hinged external fixation after open reduction and internal fixation. The indication for use of a hinged external fixator was persistent instability after fixation of the fractures. Early mobilization was started at 1 week (6.5 days) after surgery. The external fixator was removed at 6 weeks after surgery. Cassebaum classification and Mayo elbow performance score were used for clinical and functional evaluation. The follow-up period was at least 1 year.

Results

At the last follow-up, the average further flexion was 127°, and the average flexion contracture was 16°. The average pronation was 83° and the average supination was 78°. By the Cassebaum classification after 1 year follow-up, patients were classified as 4 excellent, 4 good, and 2 poor. According to the Mayo elbow performance score, the average score was 87 points (65-100 points) with 3 excellent, 6 good, and 1 fair. Stability was restored in all patients at the last follow-up. There was no case of nonunion and the average union period was 11.5 weeks.

Conclusion

This study advocated the additional use of a hinged external fixator in the treatment of complex elbow instability, especially when fixation of fractures and repair of soft tissues were not sufficient. Providing adequate stability and allowing early motion, additional external fixation could improve the functional outcome.

Keywords: Elbow, Terrible triad, External fixator

Figures and Tables

Fig. 1

A 33-year-old male, initial radiographs and computed tomography showed fracture of the radial head, coronoid process and olecranon process of ulna, and elbow dislocation. Postoperative radiographs show resection arthroplasty for radial head fracture, circlage wiringfor coronoid process fracture, and tension band wiring for olecranon process fractures and hinged external fixation for elbow instability. (A) Preoperative elbow anteroposterior (AP) image. (B) Preoperative elbow lateral image. (C) Preoperative 3-dimensional computed tomography image. (D) Postoperative elbow AP image. (E) Postoperative elbow lateral image.

Fig. 2

A 65-year-old male, initial radiographs and computed tomography showed fracture of the radial head, coronoid process and elbow dislocation. Postoperative radiographs show fragment resection for the radial head fracture, screw fixation for coronoid process fracture, and hinged external fixation for elbow instability. (A) Preoperative elbow anteroposterior (AP) image. (B) Preoperative elbow lateral image. (C) Preoperative 3-dimensional elbow computed tomography image. (D) Postoperative elbow AP image. (E) Postoperative elbow lateral image.

Fig. 3

(A) Postoperative photo with hinged external fixator. (B) After removal of a rod of the external fixator and loosening the hinge, patients started elbow joint movement. One week after surgery.

Table 1

Summary of Cases

R: Right, L: Left, M: Male, F: Female.

Table 2

Cassebaum Classification for Elbow Range of Motion

Table 3

Mayo Elbow Performance Score

Classification: Excellent >90; Good 75-89; Fair 60-74; Poor <60.

Notes

^{Financial support} This research was supported by grant from the Inha University and Inha University Hospital.

^{Conflict of interest} None.

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