Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies...

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Published in:Clinical orthopaedics and related research 2015-04, Vol.473 (4), p.1451-1461
Main Authors: Iordens, Gijs I. T., Den Hartog, Dennis, Van Lieshout, Esther M. M., Tuinebreijer, Wim E., De Haan, Jeroen, Patka, Peter, Verhofstad, Michael H. J., Schep, Niels W. L.
Format: Article
Language:English
Subjects:
Adult
Clinical Research
Conservative Orthopedics
Elbow
Elbow Injuries
Elbow Joint - physiopathology
External Fixators
Female
Humans
Joint Dislocations - physiopathology
Joint Dislocations - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Orthopedic Procedures - methods
Orthopedics
Pain Measurement
Prospective Studies
Range of Motion, Articular
Recovery of Function
Sports Medicine
Surgery
Surgical Orthopedics
Treatment Outcome
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Summary:Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment? Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand ( Quick DASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year. Results All functional and pain scores improved. The median Quick DASH score decreased from 30 (25 th –75 th percentiles [P 25 –P 75 ], 23–40) at 6 weeks to 7 (P 25 –P 75 , 2–12) at 1 year with a median difference of −25 (p 
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-014-3959-1