Operative Strategy for Fracture-Dislocation of the Elbow

The elbow joint is one of the most inherently stable articulations of the skeleton [49]. When in addition to the dislocation of the joint at least one of the osseous or articular component structures that contribute to the stability of the elbow is disrupted, the injury is termed “fracture-dislocation of the elbow” and the risk of recurrent or chronic instability and the development of post-traumtatic arthritis of the elbow are increased [2, 11–13, 17, 18]. Treatment of these injuries is challenging due to difficulties in applying accurate definitions of the patterns of the injury, in evaluating the specific roles of the component structures that contribute to the instability of the elbow and the lack of a standardized rationale for the operative treatment. Soft tissue injury including open wounds and vascular or nerve compromise add to the complexity of the injury. In recent years investigative efforts were put into the definition of the components that contribute to the stability of the elbow and the concept of operative fixation of the osseous and ligamentous lesions (i.e., articular fragments of the distal humerus [7, 20, 31, 32, 35, 36], the radial head [33, 41], the coronoid process [3, 14, 15, 21, 34, 59, 61–64, 72, 75], the olecranon [16, 42, 50, 51, 65, 70] the collateral ligaments [18, 54, 76] and combinations of these lesions [19, 28, 29, 37, 38, 43–45, 58, 60, 67, 68, 78] in order to reconstitute elbow stability. In addition to this more recently the development and use of the trans-articular external fixator with motion capacity of the elbow has extensively broadened the therapeutic spectrum of treating complex elbow trauma and partially changed therapeutic pathways [6, 10, 22–27, 39, 40, 46–48, 52, 55, 57, 66, 69, 71, 77]. The purpose of this lecture is to analyse the ­current literature and own prospective data in order to establish and discuss a strategy in the treatment fracture-dislocations of the elbow (Fig. 1).