A new technique for surgical management of old unreduced elbow dislocations: Results and analysis

• Main Authors: Parag Garg, Soumya Paik, Sisir Sahoo, Vimal Raj, Aniruddha Pispati, Subhashish Mitra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-01-01
• Series: Journal of Orthopaedics and Allied Sciences
• Subjects: Cruciate ligament; old elbow dislocation; open reduction
• Online Access: http://www.joas.in/article.asp?issn=2319-2585;year=2014;volume=2;issue=2;spage=45;epage=51;aulast=Garg

Background: Open reduction of neglected dislocations of elbow often leads to less than optimal results. Extensive release during reduction and early mobilization may lead to instability. Post-surgical immobilization to recover the stability leads to loss of range of motion. Arafiles described a technique of creating a cruciate ligament like structure to provide stability while early mobilization is advocated. We have modified this technique in several aspects. We report a retrospective analysis of 26 such cases where we evaluated and compared the standard immobilization technique of K-wires with this new modified technique. Materials and Methods: Twenty-six consecutive cases of dislocated elbow with duration ranging from 4 to 56 months were included in this study. We performed standard open reduction and fixation with K-wire followed by immobilization for 3 weeks for the first 12 cases. In the next 14 cases after standard release and reduction we provided extra stability by adding a cruciate ligament like structure both on the medial and lateral side using autologous semitendinosus graft. Post-operative mobilization was advised the very next day. We evaluated the results of this technique and compared it with the previous one using MEPI scores, complication rate and radiological evaluation.Results: The average follow-up duration for the 26 patients is 4.5 years (2−7 years). All patients achieved full functional ROM in both planes. The mean increase in the MEPI score was significantly more for group II (53.5) than group I (36.6). Movement, activities and stability was better for this group II. Complication rates for both were similar.Conclusion: Providing stability at the time of operation with a mediolateral cruciate ligament provides the option of immediate mobilization post-operatively in open reduction of neglected dislocations of elbow. Thus, this technique provides excellent results disregarding the duration of dislocation with minimal morbidity for the patient.