It involves open reduction with or without triceps lengthening and Kirschner pin fixation. For immediate assistance, contact Customer Service: Naidoo KS: Unreduced posterior dislocation of the elbow. Jupiter JB, Ring D: Treatment of unreduced elbow dislocations with hinged external fixation. The average postoperative followup was 48.3 months, with a range of 24–132 months (Table 1). Elbow dislocations are common and account for 10-25% of all elbow injuries in the adult population 1. All cases in the current study had no complaint of elbow instability at the final followup after 2 years. Try again. We found no correlation between the postoperative arc of elbow motion and duration of untreated elbow dislocation preoperative arc of elbow flexion. your express consent. By continuing to use this website you are giving consent to cookies being used. These teams include nurses and therapists who are accustomed to assisting patients in their recovery. J Bone Joint Surg 64B:603–606, 1982. Methods. Correspondence to: Prof. B. Mahaisavariya, MD, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Nonetheless, open reduction of neglected elbow dislocation either with or without triceps lengthening can offer intermediate-term and long-term postoperative functional range of elbow motion without compromising elbow stability. Mahaisavariya, Banchong*; Laupattarakasem, Wiroon†, Section Editor(s): Jain, Anil K MS(ORTHO), MAMS, GUEST EDITOR. Neglected elbow dislocations often result in contracture and functional impair-ment. To investigate the effect of open reduction operative treatment in neglected elbow dislocation. 68 0 obj <>/Filter/FlateDecode/ID[<09D6EDCB41605B73C0D661710E090C82><0290F4D2647C3748828CC174E8992C09>]/Index[47 39]/Info 46 0 R/Length 108/Prev 554853/Root 48 0 R/Size 86/Type/XRef/W[1 3 1]>>stream Phone: 662-4197968; Fax: 662-4128172 ; E-mail: [email protected]. of motionat elbow joint, and valgus deformity of elbow.4–6 There have been reports regarding tardy nerve palsy with long-standing chronic Monteggia injuries.6 A review of literature illustrates various methods for the management of neglected Monteggia fracture dislocation, such as reconstruction of annular ligament,7 osteotomy of An open reduction was done with no attempt of closed reduction by manipulation. Please enable scripts and reload this page. Elbow fracture-dislocation surgery is usually performed under general anesthesia. Descriptive statistics were computed for age at presentation, the duration of the dislocation, and preoperative and postoperative arcs of motion. For range of motion exercise, it emphasis was more on elbow flexion (between flexion 70–120o) during the first two weeks after cast removal to avoid redislocation. Case 1: 23 year old female patient had a neglected poste-rior dislocation of left elbow with ipsilateral humeral shaft fracture caused by car accident. [email protected]. h�bbd```b``� How is it treated? "Total elbow replacement is in itself a rare surgery and this is the first reported case of management of an elbow dislocation with terrible triad with an elbow replacement," said Dr Vijay. From the *Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok; and the †Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. endstream endobj startxref Surgical treatment of neglected dislocation of the elbow is a challenge for surgeons [ 9]. We used the Pearson test for correlation study to analyze our results. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. Morrey BF, Askew LJ, An KN, Chao EYS: A biomechanical study of normal functional elbow motion. Table 1: Causes of Stiff elbow. There were three patients who had associated medial epicondylar fractures (Patients 10, 12, and 16). All registration fields are required. Registered users can save articles, searches, and manage email alerts. This figure shows the result of elbow motion in flexion and extension 3 years after open reduction of 7-week neglected elbow dislocation in a patient who was 10 years old at the time of surgery. The elbow flexion and extension was measured passively with a handheld goniometer with 1o increments of measurement. J Shoulder Elbow Surg 7:573–580, 1998. to maintaining your privacy and will not share your personal information without A dislocated elbow occurs when the radius (or radius head) and/or ulna bones of the forearm are moved out of place with the humerus (upper arm) bone that together form a joint. The patient was treated after 3 months of initial trauma. The elbow is immobilized in an extended position by the splint made of multiple longitudinal strips of bamboo stuck to an underlying sheet of cloth that can be wrapped around the midarm to midforearm. The stiffness and pain complicated the function in daily activity. There are many types of elbow dislocations, but about 90% are posterior types. The elbow motion was recorded before and after the operation by the surgeon who operated on the patients. Your message has been successfully sent to your colleague. The pin was removed and the plaster slabs were discarded after 2 to 3 weeks to allow active mobilization. Clinical Orthopaedics and Related Research®431:21-25, February 2005. The posterior approach with V-Y muscleplasty was used in most patients with 2 to 3 weeks postoperative immobilization. The measurement method used to measure elbow flexion is subject to intraobserver variation up to 3°.2 Further we had only subjective evaluation of elbow stability with no definite stability test at the time of last followup. Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJW: Reliability of range-of-motion measurement in the elbow and forearm. Preoperative computed tomography scans were obtained for all patients. For patients who had dislocations for more than 3 months, various degrees of degeneration had occurred. There were no cases of myositis ossificans or patients’ complaint of elbow instability at the time of last followup. 30 mins. This is the reason that in more than ½ of the patients in our series, the duration of untreated elbow dislocation usually was between 1 and 3 months. From our experiences, collateral reconstruction may not be necessary as recommended by Arafiles.1 The ordinary repair by suturing the collateral ligament after releasing the contracture was usually sufficient. Speed JS: An operation for unreduced posterior dislocation of the elbow. most common dislocated joint in children; account for 10-25% of injuries to the elbow ; posterolateral is the most common type of dislocation (80%) demographics . In all except two patients in this study, the operation was done using Speed’s posterior approach9 with some modifications. This was because the nerve was obviously stretched during soft tissue release and passive flexion of the elbow to 90°. You may be trying to access this site from a secured browser on the server. Elbow deformity in children due to neglected proper fracture management is a devastating condition. The differential diagnoses were neglected dislocation of the elbow joint (posterior/anterior) and mal-united supracondylar fracture. Arafiles RP: Neglected posterior dislocation of the elbow: A reconstruction operation. The patient later consults an orthopaedic surgeon because of the inability to flex the elbow. Fowles JV, Kassab MT, Douik M: Untreated posterior dislocation in children. This treatment does not, however, protect from possible stiffness of the elbow [ 2] [ 3] [ 6] [ 12] [ 13]. An isolated dislocation without fracture is "simple." The scattergram shows a low level of correlation between the patient age at the time of open reduction of neglected elbow dislocation and the final arc of elbow motion (r = 0.503, p = 0.012). We retrospectively identified 72 patients with unreduced posterior elbow dislocation for more than 1 month. Lippincott Journals Subscribers please login with your username or email along with your password. When all of t… 85 0 obj <>stream It has been reported6 that some older patients had very good results even after a short period of rehabilitation (Fig 3). Neglected elbow dislocation is defined as dislocation which is left unreduced for more than 3 weeks 3 - 6. 7. The aim of treatment of a neglected elbow dislocation is to achieve the functional range [1,4,5]. Our study has shown a low level of correlation to the final arc of elbow flexion. The average preoperative arc of elbow flexion was from 17[degrees] with an average maximum flexion of 27[degrees] (range, 5-60[degrees]) and an average flexion contracture of 10[degrees] (range, 0-30[degrees]). The delay of management of patients is often due to the initial recourse to [1]. Further, a hinge external fixator is generally not affordable or practical on a routine basis in developing countries. The fracture-dislocations were included in our series. "w�����Al�y ��D�������&���u10҄���t�#@� �mT Clinical Orthopaedics and Related Research: Clinical Details of the Patients and Results after Open Reduction of Neglected Posterior Dislocation of the Elbow. To achieve stable and concentric reduction, the complete clearance of fibro-osseous tissue from the trochlear notch, the olecranon fossa, and the coronoid fossa and complete reduction of the radiohumeral joint are important. In most cases, the articular surface was covered by fibrosis. However, there was no correlation of the postoperative arcs of the elbow flexion to the preoperative arc of motion. Introduction ‘Unreduced elbow’ is defined as a posterior elbow dislocation not treated within 3 weeks of injury.9, 13, 16, 18 Such an elbow is fixed in either extension or flexion, with only a few degrees of flexion, supination or pronation, and has a range of movement that is inadequate for the activities of daily living. The dislocations were 8.5 ± 4.2 months old on average (range 2 to 17 months). 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Men and six women whose ages ranged from 1 to 60 years pried using... Was measured passively with a distal J-shaped curve so that the radial head,!