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Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results.

ABSTRACT: OBJECTIVES:To describe the surgical treatment and patient outcomes of chronic elbow dislocations. DESIGN:Retrospective review. SETTING:Two tertiary referral centers. PATIENTS/PARTICIPANTS:All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015. INTERVENTION:Review of patient demographics, injury chronicity, surgical technique, and patient outcomes. MAIN OUTCOME MEASUREMENT:Clinical outcomes included elbow range of motion and complications. Radiographic outcomes included the presence of heterotopic ossification. Patient-reported outcomes included the Mayo Elbow Performance Index (MEPI) and the Summary Outcome Determination (SOD). RESULTS:Thirty-two patients with mean follow-up of 22 months (range, 13-41 months) were included. The mean dislocation duration was 6 months (range, 1-34 months). The mean preoperative range of motion was 8 degrees (range, 0-30 degrees). There were no infections or recurrent dislocations. One patient developed transient ulnar nerve palsy postoperatively. There were no cases of new or progressive heterotopic ossification. The mean postoperative extension was 31 degrees (range, 0-75 degrees), and the mean postoperative flexion was 132 degrees (range, 95-150 degrees); the mean final arc of motion was 101 degrees (range, 50-140 degrees). The mean postoperative MEPI was 93 (range, 70-100), and the mean SOD score was 9 (range, 6-10). Using the MEPI, 97% (31/32 patients) had good or excellent outcome. There was no difference in flexion/extension arc or MEPI scores between groups of elbows older and younger than 17 years or dislocations less or more than 3 months. CONCLUSION:This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

SUBMITTER: Anderson DR

PROVIDER: S-EPMC5844584 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results.

Anderson Duane R DR Haller Justin M JM Anderson Lucas A LA Hailu Samuel S Chala Abebe A OʼDriscoll Shawn W SW

Journal of orthopaedic trauma 20180401 4

<h4>Objectives</h4>To describe the surgical treatment and patient outcomes of chronic elbow dislocations.<h4>Design</h4>Retrospective review.<h4>Setting</h4>Two tertiary referral centers.<h4>Patients/participants</h4>All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015.<h4>Intervention</h4>Review of patient demographics, injury chronicity, surgical technique, and patient outcomes.<h4>Main outcome measurement</h4>Cl ...[more]

PMID: 29240012

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Project description:BackgroundSimple elbow dislocation occurs at an incidence of 2.9 to 5.21 dislocations per 100,000 person-years, with as many as 62% of these patients experiencing long-term elbow joint contracture, stiffness, and/or pain. Poor outcomes and the need for secondary surgical intervention can often be prevented nonoperatively with early or immediate active mobilization and physical therapy. However, immobilization or limited mobilization may be necessary following trauma, and it is unknown how different periods of immobilization affect pathological changes in elbow joint tissue and how these changes relate to range of motion (ROM). The purpose of this study was to investigate the effects of varying the initiation of free mobilization on elbow ROM and histological features in an animal model of elbow posttraumatic joint contracture.MethodsTraumatic elbow dislocation was surgically induced unilaterally in rats. Injured forelimbs were immobilized in bandages for 3, 7, 14, or 21 days; free mobilization was then allowed until 42 days after injury. Post-mortem joint ROM testing and histological analysis were performed. One-way analysis of variance was used to compare ROM data between control and injured groups, and Pearson correlations were performed between ROM parameters and histological outcomes.ResultsLonger immobilization periods resulted in greater ROM reductions. The anterior and posterior capsule showed increases in cellularity, fibroblasts, adhesions, fibrosis, and thickness, whereas the measured outcomes in cartilage were mostly unaffected. All measured histological characteristics of the capsule were negatively correlated with ROM, indicating that higher degrees of pathology corresponded with less ROM.ConclusionsLonger immobilization periods resulted in greater ROM reductions, which correlated with worse histological outcomes in the capsule in an animal model of posttraumatic elbow contracture. The subtle differences in the timing of ROM and capsule tissue changes revealed in the present study provide new insight into the distinct timelines of biomechanical changes as well as regional tissue pathology.Clinical relevanceThis study showed that beginning active mobilization 3 days after injury minimized posttraumatic joint contracture, thereby supporting an immediate-motion clinical treatment strategy (when possible). Furthermore, uninjured but pathologically altered periarticular tissues near the injury location may contribute to more severe contracture during longer immobilization periods as the disease state progresses.

Project description:BACKGROUND: Surgical hip dislocation allows for a 360° view of the acetabulum and may facilitate a reduction in selected acetabular fractures. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. DESCRIPTION OF TECHNIQUE: The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. T-type, transverse fractures alone or associated with posterior wall could be reduced with specific clamps and reduction adequacy can be judged by direct view. Anterior column fixation could be performed with one or two screws; the posterior column could be fixed with a single posterior plate or with two plates if a transverse fracture is associated with a posterior wall fracture. METHODS: Between 2005 and 2011, we used this approach selectively to manage those types of fractures; during the period in question, we treated 312 acetabular fractures surgically, of which 31 (10%) were treated using this approach. Patient demographic, injury, and surgical variables as well as complications were recorded. Outcomes were evaluated with the Merle d'Aubigné and Postel system. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs (AP and Judet views). Minimum followup was 24 months (mean, 43 months; range, 24-87 months). RESULTS: Fracture reduction was defined as anatomic in 65% cases, imperfect in 16%, and poor in 19%. Mean Merle d'Aubigné score was 15 points (out of 18, with higher scores being better). Two patients developed symptomatic femoral head avascular necrosis. CONCLUSIONS: In complex cases, surgical dislocation presents several advantages; a single approach may reduce surgical time, permit direct intraarticular assessment, and facilitate screw placement closer to the articular surface. It also presents several limitations; some difficulties with bone-reduction clamp positioning, limited fixation of the anterior column, and a small risk of greater trochanter malunion.

Project description:BackgroundElbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint's Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist.Materials and methodsMeasures were taken simultaneously with inertial sensors (Werium™ system) and a universal goniometer. The process involved two physiotherapists ("rater A" and "rater B") and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r 2) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland-Altman plots were also calculated.ResultsSimilar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99.ConclusionsInertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.

Dataset Information

Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results.

Publications

Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results.

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