An overview about elbow instability

TREATMENT OF SIMPLE CHRONIC INSTABILITY OF THE ELBOW JOINT

Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.

Pediatric trans-olecranon fracture dislocation of the elbow associated with fracture of the radial head and with medial collateral ligament lesion: A case report and review of the literature

Introduction

We report what is, to the best of our knowledge, the first case of pediatric trans-olecranon fracture dislocation of the elbow associated with a radial head fracture and with a medial collateral ligament disruption.

Case presentation

A 7-year-old girl presented to the emergency department after a fell on his right elbow while playful activity at home. The elbow X-ray showed acute trans-olecranon fracture dislocation of the elbow associated with a radial head fracture. A pre-operative 3D TC scans confirmed and clarified the injury pattern. However, stress radiographs performed in the operating room under anesthesia revealed an associated severe valgus instability caused by medial collateral ligament disruption. The olecranon fracture was fixed with two crossing 1.5 mm K-wires and the angulated radial neck fracture was fixed with a retrograde 1.5 mm K-wire by S.E.R.I. technique.

Conclusion

Although trans-olecranon fracture dislocation of the elbow is well recognized and clearly described in adults, it is uncommon in children. A pre-operative 3D TC scans are recommended to enable a more accurate diagnosis and surgical planning. Medial collateral ligament has a central role in elbow stability and is very important to repair it during surgery.

Elbow instability: Are we able to classify it? Review of the literature and proposal of an all-inclusive classification system

BACKGROUND

In the recent years, considerable improvements have come in biomechanical knowledge about the role of elbow stabilizers. In particular, the complex interactions among the different stabilizers when injured at the same time have been better understood. Anyway, uncertainties about both nomenclature and classification still exist in the definition of the different patterns of instability.

MATERIAL AND METHODS

The authors examine the literature of the last 130 years about elbow instability classification, analyzing the intuitions and the value of each of them. However, because of the lack of a satisfactory classification, in 2015 a working group has been created inside SICSeG (Italian Society of Shoulder and Elbow Surgery) with the aim of defining an exhaustive classification as simple, complete and reproducible as possible.

RESULTS

A new all-inclusive elbow instability classification is proposed. This classification considers two main parameters: timing (acute and chronic forms) and involved stabilizers (simple and complex forms), and four secondary parameters: etiology (traumatic, rheumatic, congenital…), the involved joint (radius and ulna as a single unit articulating with the humerus or the proximal radio-ulnar joint), the degree of displacement (dislocation or subluxation) and the mechanism of instability or dislocation (PLRI, PMRI, direct axial loading, pure varus or valgus stress).

CONCLUSIONS

This classification is at the same time complete enough to include all the instability patterns and practical enough to be effectively used in the clinical practice. This classification can help in defining a shared language, can improve our understanding of the disorder, reduce misunderstanding of diagnosis and improve comparison among different case series.