ElbowElbow Dislocation With Intra-Articular Fracture: The Results of Operative Treatment Without Repair of the Medial Collateral Ligament
Section snippets
Materials and Methods
Over a 5-year period (from 1999 to 2004) 1 surgeon operated on 49 patients with a posterior dislocation of the elbow associated with one or more intra-articular fractures. Inclusion criteria were based on adherence to the following treatment protocol: 1) All fractures were either repaired (ie, open reduction and internal fixation) or reconstructed with a prosthesis; 2) The lateral collateral ligament was reattached to its origin from the lateral epicondyle; 3) The MCL was not repaired; 4)
Instability
Two patients experienced complications related to postoperative instability, both associated with noncompliance and inappropriate use of the arm. One patient with a complex articular fracture of the distal humerus did not return to the office for a month after surgery, at which time she was noted to have discarded her splint, used her arm inappropriately, and subluxated the elbow. The other patient with a terrible triad injury of the elbow had a dislocation when she was riding her bicycle
Discussion
Some surgeons treating acute traumatic elbow instability have been slow to adjust from the traditional focus on the MCL to the increasing importance placed on the LCL.16 The role of the MCL in traumatic elbow instability may have been overinterpreted in the light of biomechanical studies demonstrating its important role in valgus stability of the elbow. The contributions of the MCL are easier to isolate in the lab,19, 20, 31 and complete dislocation of the elbow occurs in the presence of both
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Supported by Wright Medical, AO Foundation, Smith & Nephew, Small Bone Innovations, Joint Active Systems, and Biomet.
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Equal contribution.