Open reduction and provisional arthrodesis for neglected elbow dislocation

Abstract

Elbow dislocation, often resulting from high-energy trauma, presents a challenge when neglected, impacting joint stability and function. Various surgical interventions exist, with open reduction and provisional arthrodesis being considered effective. This study aimed to evaluate the outcomes of 22 patients with neglected elbow dislocation treated using this method.

A retrospective study of patients treated between January 2020 and December 2023 was conducted. Demographics, dislocation data, clinical and radiological findings, pre/postoperative measures, and treatment details were recorded. Surgical procedures involved open reduction, radial head resection, triceps tenoplasty, and provisional arthrodesis using Kirschner wires.

This study involved 15 patients with a mean age of 34.7 years, predominantly male (80%), with the most common comorbidity being hypertension (26.7%). Injuries were more frequent on the right side (60%), with shaft fractures of the humerus (53.3%) and Monteggia fracture dislocations (46.7%) being the most common. Most fractures were closed (60%), and a few patients experienced transient ulnar palsy (26.7%). Surgically, the average time to operation was 8.3 hours, with posterior and lateral approaches being common for the humerus and forearm, respectively. Intramedullary nailing and plating were the typical techniques used. At an average follow-up of 18 months, outcomes were moderate to good, with stable joints in 93.3% of patients. The average pain score was 2.7, and the mean range of motion (ROM) was 101.3 degrees. The mean Mayo Elbow Performance Score (MEPS) was 81.7, and the Disability of the Arm, Shoulder and Hand (DASH) score was 18.3.

The study found that neglect duration, trauma energy, dislocation type, and associated fractures significantly influenced the outcomes. The surgical technique involved open reduction, radial head resection (if necessary), triceps tenoplasty (if necessary), and provisional arthrodesis using Kirschner wires. The study results are consistent with previous research, demonstrating the efficacy of open reduction and provisional arthrodesis in treating neglected elbow dislocation, particularly in developing countries with limited healthcare access. Future research with larger samples, longer follow-up, and randomized controlled trials is needed to validate these results and compare this method with other surgical techniques.

Neglected elbow dislocation, treated via open reduction and provisional arthrodesis, demonstrated moderate to good outcomes in terms of stability, infection rates, complications, and patient satisfaction. Factors like neglect duration, trauma energy, and associated fractures significantly influenced outcomes. Postoperative ROM and function improved consistently, warranting further research to compare this method with others.