Elbow Dislocation With Intra-Articular Fracture: The Results of Operative Treatment Without Repair of the Medial Collateral Ligament

• Published in: The Journal of hand surgery (American ed.) Vol. 32; no. 8; pp. 1200 - 1209
• Main Authors: Forthman, Christopher, MD, Henket, Marjolijn, MD, Ring, David C., MD, PhD
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-10-2007; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Collateral Ligaments; Diseases of the osteoarticular system; Elbow fracture-dislocation; Elbow Joint - injuries; Elbow Joint - surgery; Female; Fracture Fixation, Internal; Humans; Injuries of the limb. Injuries of the spine; Joint Dislocations - surgery; Joint Prosthesis; Male; Medical sciences; Middle Aged; operative treatment; Orthopedic surgery; Orthopedics; Radius Fractures - surgery; Range of Motion, Articular; Rotation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Sutures; Traumas. Diseases due to physical agents; traumatic instability; Treatment Outcome; Ulna Fractures - surgery; traumatic instability; Elbow fracture-dislocation; operative treatment; Human; Postoperative; Fracture dislocation; Ligament; Radius; Internal fixation; Luxation; Radial head; Diseases of the osteoarticular system; Osteosynthesis; Trauma; Forearm; Treatment; Orthopedics; Lateral ligament; Instability; Coronoid process; Bone; Repair; Elbow
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2007.06.019

Purpose To determine the effectiveness of a protocol for the treatment of fracture-dislocations of the elbow based on the concept that, if dislocation of the elbow with associated fractures can be made to resemble a simple elbow dislocation by repairing or reconstructing the fractured structures, repair of the medial collateral ligament (MCL) will not be necessary. Methods Over a 5-year period, a single surgeon operated on 34 patients with a posterior dislocation of the elbow associated with one or more intra-articular fractures. The mean age of these 19 men and 15 women was 48 years. Associated fractures included the capitellum, trochlea, and lateral epicondyle in 3 patients; the olecranon in 1 patient; and the radial head in 30 patients (with concomitant fracture of the coronoid process—the so-called “terrible triad” of the elbow—in 22 patients, and concomitant fracture of the coronoid and olecranon in 1 patient). Operative treatment consisted of open reduction internal fixation (ORIF) or prosthetic replacement of all fractures and reattachment of the origin of the lateral collateral ligament (LCL) complex to the lateral epicondyle. The MCL was not repaired. Results Two patients (1 with a terrible triad injury and 1 with fracture of the capitellum and trochlea) had postoperative instability related to noncompliance, had reconstructive procedures, and were considered failures. An average of 32 months after injury, the remaining 32 patients regained an average of 120° ulnohumeral motion and 142° forearm rotation. Twenty-five of 34 patients (74%) had good or excellent results according to the system of Broberg and Morrey. Patients with terrible triad injuries had an average of 117° ulnohumeral motion and 137° forearm rotation, and 17 of 22 patients (77%) had good or excellent results. Conclusions MCL repair is unnecessary in the treatment of dislocation of the elbow with associated intra-articular fractures, provided that the articular fractures and the LCL are repaired or reconstructed. Type of study/level of evidence Therapeutic IV.