Reconstruction for persistent instability of the elbow after coronoid fracture-dislocation

The results of reconstruction for chronic instability after coronoid fracture have not been previously described. Patients with persistent instability after coronoid fracture-dislocation were assessed after reconstruction. A satisfactory outcome was considered to be present based on the Mayo Elbow P...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2007, Vol.16 (1), p.68-77
Main Authors: Papandrea, Rick F., MD, Morrey, Bernard F., MD, O’Driscoll, Shawn W., MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Elbow Joint - injuries
Elbow Joint - surgery
Female
Fractures, Bone - complications
Fractures, Bone - surgery
Humans
Injuries of the limb. Injuries of the spine
Joint Dislocations - complications
Joint Instability - etiology
Joint Instability - surgery
Male
Medical sciences
Middle Aged
Orthopedics
Traumas. Diseases due to physical agents
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Description
Summary:The results of reconstruction for chronic instability after coronoid fracture have not been previously described. Patients with persistent instability after coronoid fracture-dislocation were assessed after reconstruction. A satisfactory outcome was considered to be present based on the Mayo Elbow Performance Score and on the patient’s willingness to repeat the operation. The length of follow-up was a minimum of 2 years, averaging over 5 years. Overall, 13 of 21 patients (62%) were classified as having a successful outcome objectively, and 17 of 21 (81%) were classified as having a successful outcome subjectively. The duration of the delay to definitive treatment was closely associated with the ultimate outcome ( P < .01), as the outcome of only 1 of 7 elbows with a delay greater than 7 weeks was classified as an objective success. Of the patients, 19 had a fractured radial head, 11 of which were initially treated with a radial head excision; none was subsequently reconstructed. Sixteen patients were treated with a hinged external fixator. Of the elbows, 13 remained reduced whereas 8 had variable amounts of anterior or posterior instability. Two failures were ultimately reconstructed with a total elbow arthroplasty. Instability that persists after the initial unsuccessful management of a coronoid fracture and an elbow dislocation is a difficult problem to salvage with subsequent reconstruction. This experience emphasizes the need for better reconstructive options and especially underscores the need for appropriate initial management of this difficult injury.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2006.03.011