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Surgical Techniques   |    
Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures
Michael D. McKee, MD, FRCS(C)1; David M.W. Pugh, MD, FRCS(C)1; Lisa M. Wild, BScN1; Emil H. Schemitsch, MD, FRCS(C)1; Graham J.W. King, MD, MSc, FRCS(C)2
1 Upper Extremity Reconstructive Service, St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address for M.D. McKee: mckee@the-wire.com
2 University of Western Ontario, Hand and Upper Limb Centre, 268 Grosvenor Street, London, ON N6A 4L6, Canada
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).
Investigation performed at Upper Extremity Reconstructive Service, St. Michael's Hospital, and University of Western Ontario, Hand and Upper Limb Centre, London, Ontario, Canada
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 1122-1130, June 2004

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(1 suppl 1):22-32. doi: 10.2106/JBJS.D.02933
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Abstract

BACKGROUND:

The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at seven to ten days postoperatively and enhance functional outcome.

METHODS:

We retrospectively reviewed the results of this treatment performed, at two university-affiliated teaching hospitals, in thirty-six consecutive patients (thirty-six elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvanthinged external fixation. Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up.

RESULTS:

At a mean of thirty-four months postoperatively, the flexion-extension arc of the elbow averaged 112° ± 11° and forearm rotation averaged 136° ± 16°. The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to fifteen excellent results, thirteen good results, seven fair results, and one poor result. Concentric stability was restored to thirty-four elbows. Eight patients had complications requiring a reoperation: two had a synostosis; one, recurrent instability; four, hardware removal and elbow release; and one, a wound infection.

CONCLUSIONS:

Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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