Ulnohumeral Cross-Pinning in the Management of Traumatic Elbow Instability.

PURPOSE: Traumatic elbow instability (subluxation and dislocation) represents a challenging clinical entity that can be complicated by persistent intraoperative instability after attempted stabilization or recurrent postoperative instability. Both static and dynamic supplemental stabilization procedures have been described for cases where fracture fixation and ligament repair fail to restore stability. There is a paucity of prior studies involving ulnohumeral cross-pinning (UCP), which is a type of static supplemental stabilization. Our purpose was to assess complications and outcomes after UCP. METHODS: We reviewed all surgical cases involving primary and revision UCP for traumatic elbow instability at a single center from 2017-2023. Baseline demographics were recorded. Outcomes including radiographs, range of motion, patient-reported outcome measures, and surgical complications were analyzed. RESULTS: Fourteen patients undergoing UCP were included with a mean follow-up of 27 months. Five cross-pinnings (36%) were performed during revision procedures. Mean visual analog scale (VAS) pain, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Single Assessment Numeric Evaluation (SANE) scores were 2.4, 34, and 69, respectively. The mean flexion-extension and pronation-supination arcs were 114° and 140°, with 85% achieving at least a 100° arc for flexion and forearm rotation. Five patients (36%) had complications, all of which required reoperation. Two complications involved postoperative instability: one radial head subluxation and one radial head dislocation. Both occurred in revision UCP cases indicated for recurrent postoperative instability. CONCLUSIONS: Ulnohumeral cross-pinning for persistent and recurrent elbow instability results in maintained ulnohumeral joint alignment, functional arcs of elbow range of motion, and acceptable patient-reported outcome measures, particularly in the setting of a primary procedure indicated for persistent intraoperative instability. Ulnohumeral cross-pinning is a reasonable supplemental stabilization procedure for complex elbow instability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Lateral Ulnar Collateral Ligament Repair With Suture-Tape Augmentation for Traumatic Elbow Instability.

PURPOSE: Ligament repair with suture-tape augmentation has been used in the operative treatment of joint instability and may have advantages with respect to early motion and stability. The purpose of this investigation was to describe the clinical results of traumatic elbow instability treated with lateral ulnar collateral ligament repair with suture-tape augmentation. METHODS: All cases of acute and chronic elbow instability treated surgically between 2018 and 2020 were included if they underwent ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament as part of the procedure. Cases with <6 months of follow-up were excluded. A manual chart review was performed to record patient demographics as well as injury and surgery characteristics. Radiographic outcomes, range of motion, and patient-reported outcome measures, including the visual analog pain scale and Disabilities of the Arm, Shoulder, and Hand, were recorded. Range of motion measurements were recorded at the end of the clinical follow-up, as were surgical complications. RESULTS: Eighteen cases were included with a mean follow-up of 20 months. Five (28%) cases involved a high-energy mechanism, and 11 (62%) cases involved terrible triad fracture dislocations. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire and visual analog pain scale scores were 17 and 2, respectively. The mean flexion-extension arc was 124°, and 2 (11%) cases had <100° flexion-extension arc. There were 2 (11%) postoperative complications, and both cases had postoperative instability requiring reoperation. We observed no cases of capitellar erosion from the suture-tape material. CONCLUSIONS: For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Results of standardized treatment of elbow fracture dislocations as per their injury pattern: a retrospective cohort of 89 patients.

BACKGROUND: Elbow fracture dislocations represent difficult injuries to treat, with a high percentage of complications. Classically, they are divided into posterolateral, posteromedial and transulnar pattern. It is essential to distinguish them to guide intraoperative treatment to achieve an anatomic and stable reduction that allows early mobility. METHODS: A retrospective study of 89 adult patients diagnosed with elbow fracture dislocations who underwent a standardized surgery between 2013 and 2018 with a minimum follow-up of 12 months. Demographic data, characteristics of the injury, and associated procedures were collected. Patients were evaluated with functional scores (Mayo elbow performance score/Broberg and Morrey score) and ranges of movement at the end of the follow-up. RESULTS: The mean age was 41 ± 12 years, mostly men (82%), with an average follow-up of 29 months. We present 42 patients with posterolateral fracture dislocation (47%), 21 posteromedial (24%) and 26 transulnar (29%). The average range of motion at the end of follow-up was -12 ± 11° extension, 124 ± 20° flexion, 76 ± 16° pronation, and 73 ± 20° supination, with a Mayo elbow performance score of 88.7 ± 12 points and 87.2 ± 12 points in the Broberg and Morrey scale. Reoperation rate was 23%, with no infection or heterotopic ossification cases. Transulnar fracture dislocations have significantly worse extension and supination. As per the functional result (Mayo elbow performance score/Broberg and Morrey scale), there are no significant differences between the different patterns. CONCLUSION: Proper injury pattern recognition and a standardized surgical management lead to a stable joint and good results in range of motion. Functional results are encouraging at least at short term, despite the high reoperations rate.

Inestabilidad postraumática de codo: revisión bibliográfica / Post-traumatic instability of the elbow: review / Instabilidade pós-traumática do cotovelo: revisão bibliográfica

Introducción: Las luxaciones constituyen del 10 % al 25 % de todas las lesiones en el codo. Aproximadamente el 15% de los pacientes que la han sufrido quedan con algún síntoma compatible con inestabilidad. El objetivo de este trabajo es revisar en la literatura los diferentes tratamientos propuestos para esta complicación luego de una luxación simple de codo. Materiales y Métodos: Se realizó una búsqueda en bases de datos: Medline (interfase Pub-Med) y Bireme para estudios de los últimos diez años. Se seleccionaron los artículos que cumplieron los criterios de inclusión y exclusión, extrayendo de ellos los datos relevantes y resultados. La búsqueda arrojó un total de 596 artículos de los cuales 10 cumplían con los criterios de inclusión propuestos al iniciar la búsqueda. Discusión: Se analizaron y compararon las tasas de inestabilidad luego de la luxación, los diferentes tipos de tratamiento y las complicaciones. Conclusión: Existe consenso en la literatura analizada de que debe realizarse un examen de estabilidad del codo en agudo para definir el tratamiento. En cuanto al tratamiento en los codos que se presentan inestables la literatura es variable y faltan estudios comparativos para realizar recomendaciones.

Introduction: Dislocations are 10% to 25% of all elbow injuries. Up to 15% of patients with symptoms of instability can be observed. The aim of this study is to review in the literature the different treatments proposed for this complication after a simple elbow dislocation. Materials and Methods: The search was conducted on: Medline (PubMed interface) and Bireme including the last ten years studies. Articles that met the inclusion and exclusion criteria were selected, and the relevant data and results were extracted. We found a total of 596 articles, 10 met the inclusion criteria proposed at the start of the search. Discussion: We analyzed and compared the rates of instability after dislocation, the different types of treatment and complications. Conclusion: There is consensus in the analyzed literature that an elbow stability test should be performed in acute conditions to define the treatment.Comparative studies are lacking for recommending a definite treatment for elbow instability.

Introdução: Dislocaçõessão de 10% a 25% de todas as lesões no cotovelo. Aproximadamente 15% dos pacientes ficam com algum síntoma compatívelcom instabilidade. O objetivo deste trabalho é rever na literatura os diferentes tratamentos propostos para esta complicação a pósuma simples deslocação do cotovelo. Materiais e métodos: Uma pesquisa foi feita em bancos de dados: Medline (interface Pub-Med) e Bireme para estudos dos últimos dez anos. Foram selecionados artigos que atendem a os critérios de inclusão e exclusão, extraindo os dados relevantes e os resultados deles. A busca gerou um total de 596 artigos, dos quais 10 atendem a os critérios de incluso propostos no início da pesquisa. Discussão: Analisamos e comparamos as taxas de instabilidade após deslocamento, os diferentes tipos de tratamento e complicações. Conclusão: Existe consenso na literatura analisada segundo a qualum teste de estabilidade do cotobelo deve ser realizado em agudos para definir o tratamento. Sobre o tratamento os cotovelo sin stáveis a literatura é diversa e faltam estudos comparativos para realizar recomendações.

Inestabilidad posterolateral cronica de codo. reconstruccion ligamentaria / Chronic posterolateral elbow instability. ligament reconstruction

Introducción: El objetivo de este trabajo es evaluar los resultados de una serie de pacientes con inestabilidad posterolateral crónica de codo, tratados con reconstrucción del ligamento colateral cubital con injerto tendinoso. Materiales y Métodos: Se presentan 10 pacientes, con una edad promedio de 47 años. El tiempo entre la luxación y la cirugía fue de 16 meses. El pivot shift test bajo anestesia fue positivo en todos los casos. Bajo control radioscópico, siete pacientes tenían un estadio 1 de Horii; dos, estadio 3 y uno tenía un estadio 2. En la mayoría de los casos, se utilizó el tendón del palmar menor. El seguimiento promedio fue de 21 meses. Resultados: La flexo-extensión fue de 126-3º. El dolor fue 0 en reposo y 1 en actividad, según la escala analógica visual. El puntaje DASH promedio fue 12 y el de la Clínica Mayo de 95. Ningún paciente reportó sensación de inestabilidad. El pivot shift test con el paciente despierto fue negativo en todos los casos. Conclusiones: La reconstrucción del ligamento lateral del codo con injerto tendinoso en pacientes con inestabilidad posterolateral crónica es eficaz para lograr la estabilidad articular. Los mejores resultados se observaron en pacientes con estadios 1 y 2 de inestabilidad. No hubo casos de inestabilidad residual.

Introduction: The objective of this paper is to evaluate the results of a series of patients with posterolateral elbow instability treated with reconstruction of the ulnar collateral ligament using tendon graft. Methods: We reported 10 patients with a mean age of 47 years. Time from posterolateral dislocation to surgery was 16 months. The pivot shift test under anesthesia was positive in all patients. Seven patients had stage 1 instability according to Horii, one patient with stage 2 and two patients with stage 3 under fluoroscopy. Palmaris minor was the most common tendon used for reconstruction. Follow-up was 21 months. Results: Flexo-extension was 126-3º. Pain according to visual analogue scale was 0 at rest and 1 in activity. DASH score was 12 and Mayo Clinic score was 95. Sensation of instability was not reported by any patient. The pivot shift test in an awake patient was always negative. Conclusions: Ulnar collateral ligament reconstruction with tendon graft in patients with posterolateral elbow instability is useful to restore joint stability. Best results were observed in patients with stage 1 or 2 instability according to Horii. Residual instability was not observed.