Journal Article

Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation

Koch, Matthias, Greiner, Stefan, Bhide, Pushkar P., Kerschbaum, Maximilian

2019

Overview

Purpose Most elbow dislocations can be treated conservatively, with surgery indicated in special circumstances. Surgical options, apart from fracture fixation, range from repair or reconstruction of the damaged ligaments to static external fixation, usually entailing either a long period of immobilization followed by carefully monitored initiation of movement or dynamic external fixation. In general, no consensus regarding surgical treatment has been reached. A new method of open ligament repair and augmentation of the lateral ulnar collateral ligament using a non-absorbable suture tape in cases of acute and subacute elbow instability following dislocations has been described here, which allows an early, brace-free initiation of the full range of motion. This is the first description of the technique of internal bracing of the lateral elbow with preliminary patient outcome parameters for acute treatment of posterolateral rotatory instability. Methods Seventeen patients (14 males and 3 females) with acute or subacute posterolateral elbow instability as a result of dislocation or fracture dislocation were treated in our centre (Sporthopaedicum, Straubing, Regensburg, Germany) from 2014 to 2015 with open LUCL re-fixation and non-absorbable suture tape augmentation. The elbows were actively mobilized immediately after the operation and a maximum bracing period of 3 days. Results At 10 month median follow-up, none of the patients showed clinically apparent signs of instability or suffered subluxation or re-dislocation. One patient required re-operation for heterotopic ossification. The median range of motion was from 10° (0–40) to 130° (90–50) and median Oxford, Mayo Elbow Performance score, Simple Elbow Value, and DASH Scores were 41(29–48), 100 (70–100), 83% (60–95), and 18.5 (1.6–66), respectively. All patients reported a complete return to pre-injury level of activity. Conclusion Augmentation with a non-absorbable suture tape acting as an ‘Internal Brace’ following an elbow dislocation is a safe adjunct to primary ligament repair and may allow the early mobilization and recovery of elbow stability and range of motion. Level of evidence IV.

• Publisher: Springer Berlin Heidelberg,John Wiley & Sons, Inc
• Subject: Adolescent / Adult / Aged / Augmentation / Braces / Collateral Ligament, Ulnar - surgery / Dislocation / Dislocations / Elbow / Elbow - injuries / Elbow - surgery / Female / Females / Fixation / Fracture Dislocation - physiopathology / Fracture Dislocation - surgery / Fracture Fixation, Internal - methods / Fracture Fixation, Internal - rehabilitation / Humans / Immobilization / Joint Instability - physiopathology / Joint Instability - surgery / Ligaments / Male / Males / Medicine / Medicine & Public Health / Middle Aged / Motion stability / Orthopedics / Ossification (ectopic) / Ossification, Heterotopic - surgery / Patients / Range of Motion, Articular / Rehabilitation / Reinforcement (structures) / Reoperation / Repair / Stability / Surgery / Suture Techniques / Treatment Outcome / Young Adult