Open reduction, triceps lengthening, and collateral ligaments reconstruction in neglected elbow dislocation: a case report

Neglected elbow dislocations are common in developing countries. Neglected elbow dislocation leads to retraction of triceps muscles and collateral ligaments. This cause limitation of range of movement that is inadequate for the activities of daily living. A 48 years old man presented with stiffness on the left elbow. He fell down with arm in extension position 8 months prior to admission and was treated by a traditional bonesetter before seeking medical treatment. Active ROM of the left elbow was limited to 15ᵒ during flexion. The patient diagnosed as left elbow contracture due to neglected left elbow dislocation. Open reduction, MCL-LCL reconstruction and triceps lengthening was performed. Left elbow ROM was improved and MEPI score was good on 5 months evaluation. Open reduction surgery was done to avoid the risk of fracture or articular surface damage. The posterior approach provides good exposure to the retracted posterior structures and give easier access to perform V-Y plasty used for triceps lengthening. Collateral ligaments repair provides immediate stability and give better functional results. Docking technique was used for collateral ligaments repair using fascia lata tendon graft. Immobilization and physical rehabilitation are done to improve elbow joints range of movement. Open reduction surgery, triceps lengthening and collateral ligaments reconstruction using tendon graft from tensor fascia lata give satisfactory outcome for elbow contracture due to neglected left elbow dislocation.

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Open reduction of an old and unreduced posterior elbow dislocation

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.14 ◽

2021 ◽

Vol 6 (2) ◽

pp. 166-169

Author(s):

Tudor Mihai Gavrilă ◽

◽

Emanuel Antoneac ◽

Cristea Vlad ◽

Stefan Cristea

Keyword(s):

Open Reduction ◽

Elbow Dislocation ◽

Coronoid Process ◽

Joint Surface ◽

Collateral Ligaments ◽

Collateral Ligament ◽

Cast Immobilization ◽

Anterior Capsule ◽

Stiff Joint

The old unreduced elbow dislocation is not very frequent, but when it is found, it is a challenge for every surgeon. We present a case of 65 years old man who came to the hospital with a dislocated elbow. After the first attempt to reduce, the elbow was mobilized in sling for 2 weeks, but during a small effort, the joint dislocated again. Another two orthopedic reduction were tried, followed by cast immobilization, but the elbow dislocated again. The patient presented in our service after two months from the injury with stiff joint in a vicious position. On imagistic examinations (Rx, CT, MRI), it was found comminuted fracture of coronoid process, posterior dislocation of olecranon and both collateral ligaments were torn. An open reduction was performed during which the joint surface was cleaned up, the anterior capsule was reattached to the coronoid process with an anchor, and then, collateral ligament was restored with the help of autograft, a gracilis muscle (bone fixed with two anchors). Postoperatively, the patient slowly began to mobilize the elbow with splint protection. After a year, the patient returned for follow-up; the function was completely restored and he had no pain.

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Open reduction in neglected elbow dislocation in children: a case series

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2019.v38.63-68 ◽

2019 ◽

Vol 38 (1) ◽

pp. 63

Author(s):

Komang Agung Irianto ◽

Raymond Parung ◽

William Putera Sukmajaya

Keyword(s):

Functional Outcome ◽

Performance Index ◽

Open Reduction ◽

Case Series ◽

Elbow Dislocation ◽

Elbow Flexion ◽

Range Of Movement ◽

Average Improvement ◽

Fracture Management ◽

Average Loss

Background Elbow deformity in children due to neglected proper fracture management is a devastating condition. The stiffness and pain complicated the function in daily activity. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. In this study, we aimed to evaluate results of open reduction for neglected elbow dislocation in children. Case Description This is a case series of 13-14 years old neglected elbow dislocations, for up to 15 months. Open reduction after external distractor and followed by intensive rehabilitation was implemented. Clinical and functional outcome were evaluated within 4-7 years. Initial average elbow flexion was 53,3°, extension was 0°, arc of flexion was 53,3°, arc of pronation-supination was 150° and Mayo Elbow Performance Index (MEPI) was 80. Clinical and functional outcome were evaluated within 4-7 years. At follow-up after open reduction, the improvement in whole range of movement was significant. Average elbow flexion was 118,3°, extension was 36,67°, arc of flexion was 81,67°, arc of pronation-supination was 133°. The average improvement of flexion was 65°, arc of flexion was 31,67°, and arc of pronation-supination was 8,3°. The average loss of flexion was 15,5%, arc of flexion was 44,2%, and arc of pronation-supination was 10,7% compared with uninjured side. The average Mayo Elbow Performance Index (MEPI) was 96,67; all with excellent results. Conclusion Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

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Evaluation of talus fractures treated with fixation- correlation of functional outcome with the fracture type and wound condition

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182740 ◽

2018 ◽

Vol 4 (4) ◽

pp. 647

Author(s):

Neetin Pralhad Mahajan ◽

Nikhil Dilip Palange ◽

Eknath Pawar ◽

Amit Supe ◽

Prasannakumar G. S.

Keyword(s):

Functional Outcome ◽

Open Reduction ◽

Articular Surface ◽

Early Mobilization ◽

Angular Deformity ◽

Consecutive Series ◽

Fracture Type ◽

Type Iv ◽

Early Motion ◽

Satisfactory Outcome

Background: Fractures of talus are one of the most difficult ones to treat owing to the problems of complicated fracture patterns, wound problems, risk of osteonecrosis etc. This study aims to evaluate the relation of the fracture type and wound with the functional outcome after open reduction and fixation.Methods: The study was conducted in Sir J. J. Group of Hospitals from June 2014 to March 2018. A consecutive series of 28 patients with displaced fractures of talus were selected after approval from ethical committee. All patients were operated and evaluated at average of 6 months after surgery.Results: The Hawkins score was used to evaluate the functional outcome. 60% of patients of type II gained good to very good score as compared to 40% of patients of type III and 30% of type IV. With increase in severity of the fracture, percentage of score decreased.Conclusions: Most precise method of restoring and maintaining the anatomy of talus fracture is open reduction and internal fixation to allow early motion. Surgery for displaced fractures consists of anatomically correct reconstruction to avoid articular surface incongruence and angular deformity as well as preservation and rapid restoration of talar blood supply. This will ensure early mobilization and satisfactory outcome. Open fractures have worse functional outcome than closed fractures owing to lower union rates, higher osteonecrosis rates and higher re-operation and infection rates.

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Open Reduction and Screw Fixation of Mallet Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.10.012 ◽

2004 ◽

Vol 29 (2) ◽

pp. 135-138 ◽

Cited By ~ 62

Author(s):

S. C. KRONLAGE ◽

D. FAUST

Keyword(s):

Open Reduction ◽

Screw Fixation ◽

Articular Surface ◽

Joint Space ◽

Satisfactory Outcome ◽

Loss Of Reduction ◽

Secondary Procedures ◽

Distal Interphalangeal ◽

The Mean ◽

Extensor Lag

Twelve patients with mallet fractures treated by open reduction and internal fixation with small screws were reviewed at an average of 31 months after surgery. The indication for surgery was a fracture involving more than one-third of the distal phalanx articular surface or with subluxation of the distal interphalangeal joint. Loss of reduction occurred in one patient and in another one screw loosened slightly without loss of reduction. There were no nail deformities, infections, or secondary procedures. The mean range of motion was from 6° (range, 0–30°) (extensor lag) to 70° (range, 60–90°) flexion. Ten patients had no evidence of degenerative changes, one had minor joint space narrowing and one had significant deformity. Open reduction and screw fixation with small screws can lead to satisfactory outcome in appropriate patients.

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Treatment of Phalangeal Fractures by Tension Band Wiring

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0499 ◽

2001 ◽

Vol 26 (1) ◽

pp. 50-52 ◽

Cited By ~ 22

Author(s):

Y. SAFOURY

Keyword(s):

Retrospective Study ◽

Open Reduction ◽

Tension Band ◽

Tension Band Wiring ◽

Range Of Movement ◽

Intraarticular Fractures ◽

Phalangeal Fractures

This retrospective study assessed the outcomes of 30 patients with phalangeal fractures which were treated by open reduction and tension band wiring. Oblique, transverse and comminuted extraarticular fractures, as well as intraarticular fractures, were treated with this technique and they all united in about 8 weeks. There were no significant complications. At a mean follow-up period of 2.3 years, the active range of movement of the involved fingers was excellent in 17, and good in 13 instances. There were no fair or poor results.

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Inveterate elbow dislocation: surgical reduction with triceps lengthening

British Journal of Medical and Health Research ◽

10.46624/bjmhr.2021.v8.i9.001 ◽

2021 ◽

Vol 8 (9) ◽

Keyword(s):

Mayo Clinic ◽

Physical Therapist ◽

Elbow Dislocation ◽

Elbow Flexion ◽

Plaster Cast ◽

Lateral Approach ◽

Surgical Reduction ◽

Left Elbow ◽

Triceps Muscle ◽

K Wires

Inveterate elbow dislocations remain common in developing countries. We report the case of a 17-year-old child who consulted us after six months of trauma to the left elbow. Clinical examination revealed a deformed elbow, locked in extension with a mobility sector of 5°. The Mayo Clinic Elbow performance score was sixty-six; the downstream vasculo-nervous examination was normal. The face and profile X-ray of the elbow showed a pure posterolateral elbow dislocation. We used the posterior medial para-tricipital and lateral approach, a first stage of arthrolysis was performed. A complete reduction was achieved by progressive and non-traumatic gentle maneuvers. Intraoperative elbow flexion was less than 80°, indicating a retraction of the triceps muscle, so a Z-lengthening plasty was necessary. This reduction was then fixed with two olecranon-humeral K-wires. At the third week, the plaster cast and K-wires were removed. The patient was subsequently referred to a physical therapist. After a ten-month follow-up, an undistorted and functional elbow with a gain of twenty-one points according to the Mayo Clinic score was obtained. Surgical reduction of a neglected elbow dislocation with triceps lengthening plasty, followed by a codified physical therapy program, results in a remarkable restoration of elbow function and stability. Keyword : elbow, dislocation, inveterate, reduction, triceps.

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Elbow Dislocation and Articular Fracture of the Distal Humerus

Shoulder & Elbow ◽

10.1111/j.1758-5740.2010.00049.x ◽

2010 ◽

Vol 2 (2) ◽

pp. 111-117 ◽

Cited By ~ 1

Author(s):

Thierry G. Guitton ◽

Andrew D. Duckworth ◽

Margaret M. Mcqueen ◽

Peter Kloen ◽

David Ring

Keyword(s):

Medial Collateral Ligament ◽

Articular Surface ◽

Present Report ◽

Elbow Dislocation ◽

Distal Humerus ◽

Fracture Dislocation ◽

Elbow Fracture ◽

Collateral Ligament ◽

Articular Fracture

Background The present report describes subluxation and dislocation of the elbow with articular fracture of the distal humerus and injury to the medial collateral ligament, a type of elbow fracture-dislocation about which little is available in the literature. Methods Twenty-two patients with subluxation or dislocation of the elbow (with injury to the medial collateral ligament) and a fracture of the distal humerus articular surface (capitellum/trochlea) were identified. Seventeen patients had a minimum of 12 months follow-up and eight patients returned for a long-term follow-up at a median of 36 months (range 12 months to 154 months) after injury. Results Nine patients had one or more subsequent surgeries. Seven patients had surgery to address complications and two had a planned implant removal. The final median arc of elbow flexion was 120° (range 100° to 145°) and the median arc of forearm rotation was 175° (range 150° to 180°). The median Broberg and Morrey score was 88 points (range 63 points to 100 points) and the median Disabilities of the Arm Shoulder and Hand score was 9 points (range 1 point to 43 points). Discussion Some elbow dislocations and subluxations are associated with osteochondral fractures of the distal humeral articular surface.

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The Late Reduction of Carpal Dislocations

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(92)90073-b ◽

1992 ◽

Vol 17 (2) ◽

pp. 137-139 ◽

Cited By ~ 11

Author(s):

I. G. C. WEIR

Keyword(s):

Surgical Treatment ◽

Open Reduction ◽

Late Presentation ◽

Range Of Movement ◽

Manual Work ◽

X Ray ◽

Radial Styloid ◽

Reasonable Choice

Five cases are reported in which open reduction of a lunate or peri-lunar dislocation was carried out after a delay of two weeks to six months. Results were poor in terms of range of movement and X-ray appearance, but function was surprisingly good, all patients returning to normal activities including heavy manual work. One patient later underwent excision of the radial styloid with an avascular scaphoid fragment; this apart, there were no requests for further surgical treatment. Open reduction remains a reasonable choice in the treatment of late presentation of lunate and perilunar dislocation.

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Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.08.001 ◽

2018 ◽

Vol 24 (1) ◽

pp. 84-89

Author(s):

Rayan Ahmed ◽

Kotb Ahmed ◽

M. Elmoatasem Elhussein ◽

Samir Shady ◽

Tamer A. El-Sobky ◽

...

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Internal Fixation ◽

External Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Articular Surface ◽

High Energy ◽

Complication Rates ◽

Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

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Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Case Reports in Orthopedics ◽

10.1155/2015/871429 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Simon Vandergugten ◽

Serge Troussel ◽

Bernard Lefebvre

Keyword(s):

Avascular Necrosis ◽

Radial Head ◽

Elbow Joint ◽

Open Reduction ◽

Articular Surface ◽

Coronoid Process ◽

Radial Neck Fracture ◽

Radial Neck ◽

Neck Fracture ◽

Initial Fracture

In a case of a neglected radial neck fracture in childhood, the management of initial fracture and its complications are subjected to discussion. In children, open reduction should be avoided but an angulation less than 30° must be obtained. Several techniques exist to manage symptomatic malunion in adults, including resection, prosthesis, and osteotomy. When performing an osteotomy, it is important first to preserve an intact osseous hinge to avoid avascular necrosis and second to align the edge of the radial head articular surface with the lateral edge of the coronoid process, in order to avoid overstuffing elbow joint.

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