Chronic complex persistent elbow instability: a consecutive and prospective case series and review of recent literature

Autor: Giuseppe Giannicola, Pasquale Sessa, Stefano Gumina, Piergiorgio Calella, Gianluca Cinotti
Rok vydání: 2020
Předmět:
Male
Surgical results
External Fixators
medicine.medical_treatment
Elbow
Joint Dislocations
Fracture Fixation
Internal
0302 clinical medicine
Elbow Joint
chronic complex elbow instability
Orthopedics and Sports Medicine
Prospective Studies
Major complication
Range of Motion
Articular
Ulnar nerve
Neurolysis
030222 orthopedics
Arthroplasty
Replacement
Elbow
General Medicine
Middle Aged
Monteggia-like lesion
Osteotomy
terrible triad of the elbow
Treatment Outcome
medicine.anatomical_structure
Ligament
Female
Adult
Joint Instability
musculoskeletal diseases
medicine.medical_specialty
Joint replacement
Nonunion
Young Adult
03 medical and health sciences
elbow reconstructive procedure
total elbow replacement
elbow fracture-dislocation
medicine
Humans
Aged
Fracture Dislocation
business.industry
030229 sport sciences
medicine.disease
Surgery
Chronic Disease
Radius Fractures
business
Zdroj: Journal of Shoulder and Elbow Surgery. 29:e103-e117
ISSN: 1058-2746
DOI: 10.1016/j.jse.2019.11.021
Popis: Background Chronic complex persistent elbow instability (CCPEI) is a condition that even expert elbow surgeons find challenging to treat. The results of the few studies that have dealt with the treatment of this condition are conflicting. We describe the surgical results of a consecutive prospective series of patients with CCPEI and provide a review of the recent literature. Methods We assessed 21 patients with previous failed surgical or conservative treatment, with a terrible-triad injury in 13, Monteggia-like lesion in 6, humeral shear fracture-dislocation in 1, and radial head fracture-dislocation in 1. Overall, 21 open debridement procedures, 15 ulnar nerve transpositions, 6 ulnar in situ neurolysis procedures, 7 total elbow arthroplasties, 8 radial head arthroplasties, 1 radial head resection with humeroradial anconeus interpositional arthroplasty, 4 coronoid graft reconstructions, 14 ligament retensioning procedures, 3 ulnar nonunion treatments, and 2 ulnar osteotomies were performed. Two dynamic external fixators were applied. The Mayo Elbow Performance Score, quick Disabilities of the Arm, Shoulder and Hand score, and modified American Shoulder and Elbow Surgeons score were used preoperatively and postoperatively. Results The mean follow-up period was 29.4 months. A significant improvement was found between preoperative and postoperative clinical scores and range-of-motion values. The reintervention and major complication rates were 19% and 23%, respectively. Arthritic evolution was observed in 71% of the cases. Conclusions CCPEI is a challenging condition with an uncertain prognosis. The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. The time interval between the initial trauma and index surgical procedure significantly affects the feasibility of reconstructive procedures.
Databáze: OpenAIRE
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