Treatment of neglected dislocations and fracture dislocations of the elbow using a hinged external fixator

ABSTRACT

Neglected dislocations and fracture dislocations are rare, but they are occasionally set developing countries. Treatment options include open reduction, excisional arthroplasty, arthrodesis, and hinged external fixators. This study was carried out to assess the results of treatment of neglected elbow dislocation fracture dislocations using open reduction and early active motion in a hinged external fixator. The material of this work consisted of seven patients of neglected elbow dislocations fracture dislocations. 5 cases [71.4%] were not associated with fractures and two cases [28.6%] were associated with fracture of the radial head. Three cases [42.9%] had in addition a significant bar of heterotopic ossification. All patients were treated by open reduction, excision of the loose fragments of the radial head when present excision of the heterotopic bone when present, and a hinged external fixator. Ilizarov external fixator was used in 5 cases [71.4%] and a monolateral [orthofix] fixator was used in the remaining two cases [28.6%]. The Mayo elbow performance score was used to evaluate the results. The mean score at the end of follow up ranged from 70 to 95 points out of 100 points [mean 85 points +/- 9.57]. Three cases [42.9%] were considered excellent, three [42.9%] were good, and one [14.3%] was fair. The range of movements at the end of follow up ranged from 60 to 120 degrees [mean 90 +/- 23.09]. The improvement of the range of movements was statistically significant. Open reduction and early active motion in a hinged external fixator provides an excellent option of treatment for neglected elbow dislocations and fracture dislocations. It restores congruent joint reduction, stability, and functional range of movements