Severe Traumatic Valgus Instability of the Elbow: Pathoanatomy and Outcomes of Primary Operation

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2019 Nov 10

PMID 31703693

Citations 2

Authors

Lei Zhang

Laixu Wang

Shiyang Yu

Zhanhui Lv

Peng Zhang

Cunyi Fan

Yixin Shen

Affiliations

Soon will be listed here.

Abstract

Background: The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation.

Methods: Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: The median follow-up was 37.3 months (range, 15-53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up.

Conclusions: Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

Citing Articles

Operative treatment of Mason Type III radial head fractures - A comparative analysis using PROMIS.

Carroll T, Dondapati A, Cruse J, Minto J, Hammert W, Mahmood B J Orthop. 2024; 52:129-132.

PMID: 38596621 PMC: 10999472. DOI: 10.1016/j.jor.2024.03.031.

Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study.

Solitro G, Fattori R, Smidt K, Nguyen C, Morandi M, Barton R JSES Int. 2021; 5(3):549-553.

PMID: 34136869 PMC: 8178616. DOI: 10.1016/j.jseint.2021.01.009.

References

Davidson P, Moseley Jr J, Tullos H . Radial head fracture. A potentially complex injury. Clin Orthop Relat Res. 1993; (297):224-30. View

Wapler C, Fontaine C, Mesnil P, Chantelot C . Medial collateral ligament healing after posttraumatic radial head arthroplasty: A retrospective study of 33 cases with a mean follow-up of 73 months. Hand Surg Rehabil. 2016; 35(1):44-50. DOI: 10.1016/j.hansur.2015.12.005. View

Ahmad C, Lee T, ElAttrache N . Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med. 2003; 31(3):332-7. DOI: 10.1177/03635465030310030201. View

Maripuri S, Debnath U, Rao P, Mohanty K . Simple elbow dislocation among adults: a comparative study of two different methods of treatment. Injury. 2007; 38(11):1254-8. DOI: 10.1016/j.injury.2007.02.040. View

Conway J, Jobe F, Glousman R, Pink M . Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992; 74(1):67-83. View

Ahmed I, Mistry J . The management of acute and chronic elbow instability. Orthop Clin North Am. 2015; 46(2):271-80. DOI: 10.1016/j.ocl.2014.11.008. View

Park M, Ahmad C . Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am. 2004; 86(10):2268-74. DOI: 10.2106/00004623-200410000-00020. View

Schwab G, Bennett J, Woods G, Tullos H . Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res. 1980; (146):42-52. View

Eygendaal D, Olsen B, Jensen S, Seki A, Sojbjerg J . Kinematics of partial and total ruptures of the medial collateral ligament of the elbow. J Shoulder Elbow Surg. 2000; 8(6):612-6. DOI: 10.1016/s1058-2746(99)90099-x. View

10.

Davidson P, Pink M, Perry J, Jobe F . Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. Am J Sports Med. 1995; 23(2):245-50. DOI: 10.1177/036354659502300220. View

11.

Schnetzke M, Aytac S, Studier-Fischer S, Grutzner P, Guehring T . Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study. J Orthop Surg Res. 2015; 10:128. PMC: 4545864. DOI: 10.1186/s13018-015-0273-x. View

12.

Otoshi K, Kikuchi S, Shishido H, Konno S . The proximal origins of the flexor-pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study. Surg Radiol Anat. 2013; 36(3):289-94. DOI: 10.1007/s00276-013-1168-3. View

13.

Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C . Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg. 2005; 14(4):421-4. DOI: 10.1016/j.jse.2004.11.003. View

14.

King G, Zarzour Z, Rath D, Dunning C, Patterson S, Johnson J . Metallic radial head arthroplasty improves valgus stability of the elbow. Clin Orthop Relat Res. 1999; (368):114-25. View

15.

Karbach L, Elfar J . Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am. 2017; 42(2):118-126. PMC: 5821063. DOI: 10.1016/j.jhsa.2016.11.025. View

16.

Jensen S, Deutch S, Olsen B, Sojbjerg J, Sneppen O . Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament. Efficacy of ligament repair and radial head prosthetic replacement: a cadaver study. J Bone Joint Surg Br. 2003; 85(7):1006-10. DOI: 10.1302/0301-620x.85b7.14405. View

17.

Norwood L, Shook J, Andrews J . Acute medial elbow ruptures. Am J Sports Med. 1981; 9(1):16-9. DOI: 10.1177/036354658100900103. View

18.

Williams 3rd R, Urquhart E, Altchek D . Medial collateral ligament tears in the throwing athlete. Instr Course Lect. 2004; 53:579-86. View

19.

Inoue G, Kuwahata Y . Surgical repair of traumatic medial disruption of the elbow in competitive athletes. Br J Sports Med. 1995; 29(2):139-42. PMC: 1332297. DOI: 10.1136/bjsm.29.2.139. View

20.

Gummesson C, Ward M, Atroshi I . The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006; 7:44. PMC: 1513569. DOI: 10.1186/1471-2474-7-44. View