Fracture-dislocations of the elbow joint - strategy for treatment and results

Citation
H. Lill et al., Fracture-dislocations of the elbow joint - strategy for treatment and results, ARCH ORTHOP, 121(1-2), 2001, pp. 31-37
Citations number
46
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine
Journal title
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN journal
0936-8051 → ACNP
Volume
121
Issue
1-2
Year of publication
2001
Pages
31 - 37
Database
ISI
SICI code
0936-8051(200101)121:1-2<31:FOTEJ->2.0.ZU;2-O
Abstract
Between January 1993 and December 1996, 41 patients with fracture dislocati on of the elbow joint were treated in our department. In 28 patients (media n age 46 years, range 15-77 years; 16 male, 12 female), a clinical and radi ological follow-up was obtained after median 34 months (range 12-59 months) . In addition to the humero-ulnar dislocation, isolated fractures were pres ent in 13 patients and combined fractures in 15 (all with involvement of th e radial head). Primary neurological deficits were found in 7 and open frac tures in 3 patients. In 7 patients, primary definitive surgical therapy was carried out by open reduction and internal fixation. A two-step surgical m anagement (initial closed reduction and immobilization, 5 patients with ext ernal fixator, 7 with plaster; secondary open surgical procedure) was perfo rmed in 12 and conservative treatment in 9 patients. According to the Leipz ig Elbow Score, taking subjective, clinical and radiological criteria into consideration, 4 patients achieved 'excellent' and 5 patients a 'good' resu lt. Ten patients were scored 'moderate' and 9 'poor'. The rate of secondary complications necessitating revision was 36%. Poor results were primarily caused by extensive initial soft-tissue damage, delayed definitive surgical therapy, and ectopic heterotopic ossification. In contrast, fracture local ization and degree of arthrosis were not of significant importance for the final outcome. In fracture dislocations, the goal is a primary definitive s urgical treatment aiming for early postoperative physiotherapy.