Treatment of neglected elbow dislocation is a challenging problem to orthopaedic surgeons in developing countries and little information has been written in the standard textbooks. J Shoulder Elbow Surg 7:573–580, 1998. For more information, please refer to our Privacy Policy. There are many types of elbow dislocations, but about 90% are posterior types. This could be observed from the unhealthy appearance of the cartilage, including nonshiny yellowish surface, less smoothness, and some focal areas of superficial erosion of the articular surface. 7. The aim of treatment of a neglected elbow dislocation is to achieve the functional range [1,4,5]. Similar findings were reported in our previous short-term study of patients with considerable flexion contracture of the elbow.6. The authors report eight cases of neglected dislocations of the elbow. elbow dislocations are the most common major joint dislocation second to the shoulder . Speed JS: An operation for unreduced posterior dislocation of the elbow. A … The mean followup was 48.3 months (range, 12–132 months). predominantly affects patients between age 10-20 years old; Pathophysiology . Only the elbow motions in flexion and extension were recorded. Neglected elbow dislocations often result in contracture and functional impair-ment. J Bone Joint Surg 75B:426–428, 1993. If an elbow dislocation is associated with a fracture (fracture-dislocation), it is called "complex." The operative technique in most cases in this series was similar by using Speed’s posterior approach9 with V-Y muscleplasty and the postoperative program was similar. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire … Table 1: Causes of Stiff elbow. Mahaisavariya, Banchong*; Laupattarakasem, Wiroon†, Section Editor(s): Jain, Anil K MS(ORTHO), MAMS, GUEST EDITOR. ©1987 British Editorial Society ofBone and Joint Surgery 0301-620X/87/2038 $2.00 Fig. 800-638-3030 (within the USA), 301-223-2300 (outside of the USA) Clinical Orthopaedics and Related Research: Clinical Details of the Patients and Results after Open Reduction of Neglected Posterior Dislocation of the Elbow. Between January 2009 and October 2010, 13 patients (mean, 27 years, nine men and four women) with old unreduced posterior dislocation of the elbow were treated by open reduction and removal of fibrous tissue between distal humerus and ulna with Kirschner wire fixation … The tricipital tongue flap was sutured in an inverted V-Y plasty. Your message has been successfully sent to your colleague. A dislocated elbow occurs when the radius (or radius head) and/or ulna bones of the forearm are moved out of place with the humerus (upper arm) bone that together form a joint. Surgical treatment is challenging because of the accompanying triceps retraction. Neglected dislocations of the elbow considered rare in West are still frequent pathologies in developing coun-tries. The elbow motion was recorded before and after the operation by the surgeon who operated on the patients. Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, February 2005 - Volume 431 - Issue - p 21-25, Articles in PubMed by Banchong Mahaisavariya, MD, Articles in Google Scholar by Banchong Mahaisavariya, MD, Other articles in this journal by Banchong Mahaisavariya, MD. Mean time from injury to surgery was 8 … Repairing of the collateral ligaments was done if possible. A posterior longitudinal incision was made with a distal J-shaped curve so that the radial head could be exposed. The average preoperative arc of elbow flexion was from 17[degrees] with an average maximum flexion of 27[degrees] (range, 5-60[degrees]) and an average flexion contracture of 10[degrees] (range, 0-30[degrees]). Elbow fracture-dislocation surgery is usually performed under general anesthesia. A young Nigerian patient with a neglected elbow dislocation benefited from reconstructive surgery to restore mobility and flexibility of the joint. Causes are trauma usually due to falling with an outstretched arm. J Bone Joint Surg 69B:199–202, 1987. Try again. The duration of untreated dislocation ranged from 1 to 60 months (average, 7.9 months). One patient had an ulnar nerve neuropraxia postoperatively (Patient 3); however, the nerve function gradually recovered during the 3-month followup. Neglected anterior dislocations are less frequent than neglected posterior dislocations, because anterior shoulder dislocations are more familiar to the ortho- paedic surgeon, and their radiological diagnosis is easy (1). They usually manipulate the dislocated elbow into a straight position without reduction. We retrospectively review the intermediate-term to long-term results of 24 patients treated after late open reduction of neglected posterior elbow dislocation in terms of the elbow, particularly noting joint mobility. The average preoperative arc of elbow flexion was from 17° with an average maximum flexion of 27° (range, 5–60°) and an average flexion contracture of 10° (range, 0–30°). Elbow deformity in children due to neglected proper fracture management is a devastating condition. to maintaining your privacy and will not share your personal information without We wanted to share our experience in treating these neglected dislocations using the posterior approach. In Thailand, the untreated or neglected posterior elbow dislocation is not uncommon, especially in provincial hospitals. It was our observation that the concentric reduction at the time of surgery may be the key to prevent later complications including limitation of range of motion, recurrent dislocation, and the feeling of instability. 4. After a brief period of attempting to regain elbow function, the patient could have poor results after the treatment from the bonesetter. Materials and Methods. your express consent. "w�����Al�y ��D�������&���u10҄���t�#@� �mT Postoperatively the flexion contractures increased by an average of 30° from 10° preoperatively to 40° (range 0–75°) postoperatively (Table 1; Fig 1). For range of motion exercise, it emphasis was more on elbow flexion (between flexion 70–120o) during the first two weeks after cast removal to avoid redislocation. Thus, neither age nor length of time since dislocation should influence the decision to perform an open reduction. This may because of a better health education and healthcare system together with the decreasing of popularity to receive the treatment from traditional bonesetters. Average elbow flexion was 46.0° ± 25.9° (10° to 90°) and the extension deficit was 19.5° ± 18.4° (0° to 60°) before the surgery. All registration fields are required. Introduction ‘Unreduced elbow’ is defined as a posterior elbow dislocation not treated within 3 weeks of injury.9, 13, 16, 18 Such an elbow is fixed in either extension or flexion, with only a few degrees of flexion, supination or pronation, and has a range of movement that is inadequate for the activities of daily living. In developing countries, neglected dislocations of the elbow are a quite common 4 and most patients initially go to local bonesetters for massage and manipulation, which only aggravates the … It has been reported6 that some older patients had very good results even after a short period of rehabilitation (Fig 3). The study included two adults and four children who underwent open reduction for subacute, untreated posterior dislocation of the elbow. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in "A$��f�H6{0i_ f+�ٓ��*0�D��� We found a low level of correlation (r = 0.503, p = 0.012) between the postoperative arcs of elbow flexion and patient age (Fig. The neglected dislocations of elbow are rare in west but still frequent presentations in developing countries, delay in treatment is due to resort to traditional quaks. Correspondence to: Prof. B. Mahaisavariya, MD, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Further, a hinge external fixator is generally not affordable or practical on a routine basis in developing countries. Our study has shown a low level of correlation to the final arc of elbow flexion. Please enable scripts and reload this page. New surgical procedure for the treatment of neglected dislocations of the elbow:DrOtman Benabdallah. Lippincott Journals Subscribers please login with your username or email along with your password. This figure shows the result of elbow motion in flexion and extension 3 years after open reduction of 7-week neglected elbow dislocation in a patient who was 10 years old at the time of surgery. 1 VOL.69 B.NO.2,MARCH 1987 I99 NEGLECTED POSTERIOR DISLOCATION OFTHE ELBOW ARECONSTRUCTION OPERATION RUBEN P.ARAFILES From theUniversity ofthePhilippines, Manila Anewtechnique forrepair ofneglected posterior dislocation oftheelbow isdescribed, consisting ofopen … most common dislocated joint in children; account for 10-25% of injuries to the elbow ; posterolateral is the most common type of dislocation (80%) demographics . Each author certifies that his institution has waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. There was no correlation between the postoperative arc of elbow motion and preoperative parameters including patient age, preoperative arc of elbow motion, or duration of untreated dislocation. endstream endobj 48 0 obj <> endobj 49 0 obj <> endobj 50 0 obj <>stream Mahaisavariya B, Laupattarakasem B, Supachutikul A, Taesiri H, Sujaritbudhunkoon S: Late reduction of dislocated elbow. 2. Most of the patients in this series had been operated on between 1983 and 1993. The differential diagnoses were neglected dislocation of the elbow joint (posterior/anterior) and mal-united supracondylar fracture. Statistical significance was set at p < 0.05. Neglected elbow dislocations often result in contracture and functional impairment. Nonetheless, open reduction of neglected elbow dislocation either with or without triceps lengthening can offer intermediate-term and long-term postoperative functional range of elbow motion without compromising elbow stability. Lippincott Journals Subscribers, use your username or email along with your password to log in. 9. When all of t… patient suffered elbow joint dislocation with fracture of the radial head after a fall from a considerable height. Laupattarakasem W, Mahaisavariya B, Mahakkanukrauh C, Jeeravipoolvarn P, Saengnipanthkul S: Old elbow dislocation: Joint mobility after open reduction. South Med J 18:193–198, 1925. When an elbow dislocation occurs, these bones are separated from their normal alignment. The dislocations were 8.5 ± 4.2 months old on average (range 2 to 17 months). 8. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. 1. J Bone Joint Surg 63A:872–878, 1981. J Bone Joint Surg 64B:603–606, 1982. The delay of management of patients is often due to the initial recourse to [1]. Registered users can save articles, searches, and manage email alerts. This study is limited by its retrospective nature and lack of concurrent controls using other approaches. Methods. It may also lead to osteoarthritis. Causes of stiff elbow are varied. J Bone Joint Surg 66A:921–926, 1984. Elbow … We wanted to share our experience in treating these neglected dislocations using the posterior approach. It may also be complicated by neurological deficits, injuries to the rotator cuff, and fractures of proximal humerus (2). Some error has occurred while processing your request. f`e`��� ̀ �@V��#���N�����$�(r�����Y���te'�0tt4�ut�( ��р�d8�$�&30��ER�Y>3r��b��jͲ�U�U��,s"Î}'K.y#+��JFE����A�q+0p�%@��� !l)� Surgical treatment of neglected dislocation of the elbow is a challenge for surgeons [ 9]. Patients then were allowed to have aggressive rehabilitation in flexion and extension after that. In 14 patients, the dislocation was reduced without triceps lengthening. In all except two patients in this study, the operation was done using Speed’s posterior approach9 with some modifications. Data is temporarily unavailable. Surgical treatment is challenging because of the accompanying triceps retraction. Anterior transposition of the ulnar nerve was done in only four cases. The fracture-dislocations were included in our series. An isolated dislocation without fracture is "simple." One report on the use of hinge external fixation has shown its advantages in enabling the patient to regain range of motion early with a good functional outcome.4 We have no experience using such external fixation. Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements etc) that might pose a conflict of interest in connection with the submitted article. The stiffness and pain complicated the function in daily activity. We retrospectively identified 72 patients with unreduced posterior elbow dislocation for more than 1 month. Most elbow dislocations will not require surgery unless serious injury has been caused to the bone, ligament or nerves. The upper value of this bracket is usually awarded in situations where your injury has caused a severe disability. Naidoo KS: Unreduced posterior dislocation of the elbow. We have performed open reduction for the joint. Clinical Orthopaedics and Related Research®431:21-25, February 2005. Please try again soon. Arafiles RP: Neglected posterior dislocation of the elbow: A reconstruction operation. The cases have been seen less often in current practice. 800-638-3030 (within the USA), 301-223-2300 (outside of the USA). The range of elbow flexion was measured preoperatively. 30 mins. It may also result in damage to ligaments, nerves or blood vessels as they are pinched by dislocated bones. Following a failed attempt at manual repositioning, the dislocation was reduced surgically and free fragments of the Phone: 662-4197968; Fax: 662-4128172 ; E-mail: [email protected]. Choosing the type of transfixing pin depended on the convenience of the surgeon. of motionat elbow joint, and valgus deformity of elbow.4–6 There have been reports regarding tardy nerve palsy with long-standing chronic Monteggia injuries.6 A review of literature illustrates various methods for the management of neglected Monteggia fracture dislocation, such as reconstruction of annular ligament,7 osteotomy of This usually is a result of a custom done by the primitive bonesetters. To investigate the effect of open reduction operative treatment in neglected elbow dislocation. J Bone Joint Surg 84A:1630–1635, 2002. Only three patients in this study were older than 40 years and the oldest patient was 60 years. Conclusion: The goals of elbow rehabilitation following Neglected Monteggia cases include restoring function by restoring motion and muscle performance; influencing scar remodeling and preventing joint contracture; and restoring or maintaining joint stability. 6. However, from our experience, the neglected elbow dislocation usually occurs in patients in low socioeconomic communities where there is poor patient compliance even if braces were available. neglected elbow dislocations treated with open reduction and hinged external fixators. Stability of the joint was tested; if redislocation occurred, a temporary pin (either a humeroulnar or humeroradial transfixing pin) was used with the elbow positioned in 90° of flexion. It involves open reduction with or without triceps lengthening and Kirschner pin fixation. The elbow stability after surgery was evaluated mostly by subjective symptoms; no specific tests were documented. The most common associated fracture in adults is a radial head fracture, although coronoid process fracture is also common. h��WmO�8�+���ݱ�B�B��-�h�X)ʇ�f!���Ҡ�3㴤�,���NQ�gl��ό�Z�8s�������Lh3\0����� a. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. Process fracture is also common function in daily activity from injury to operation was 7.9 ). Restore mobility and flexibility of the shoulder the splint usually is a devastating condition specific were. During prolong lifting or carrying heavy object patients then were allowed to have aggressive rehabilitation in flexion and extension recorded... Patients benefited from physical therapy after removal of osteosynthesis material Chinchalkar S, Stevens RS, King GJW: of... 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