29 cases of complex elbow injuries were reviewed at a mean period of 15 months. Outcome measures included MEPS and DASH score. Patients who had defined early surgery were significantly better than those in whom surgery was delayed. We concluded that Management of complex elbow injuries can be improved by early definitive surgery. The magnitude and type of soft tissue injuries should be identified. MRI scans should be liberally used for this purpose. We believe that early, adequate and appropriate management of soft tissue injuries including use of articulated external fixator for early mobilisation improves the outcome of complex elbow injuries.

Purpose: To describe the pattern of injury, surgical technique and outcomes of Monteggia type IID fracture dislocations.

Method: Design: Retrospective review of prospectively collected clinical and radiographic patient data in orthopaedic trauma database with prospectively collected outcome scores. Setting: Level 1 university based trauma center. Patients / Participants: All patients with Monteggia type IID fracture dislocations admitted from January 2000 to July 2005. Intervention: Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures. Main Outcome Measurements: Clinical outcomes: elbow range of motion, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), PREE (Patient Rated Elbow Evaluation), complications. Radiographic outcomes: quality of fracture reduction, healing time, degenerative change and heterotopic ossification.

Results: Sixteen patients were included in the study. All fractures united. There were seven complications in 6 patients including 3 contractures with associated heterotopic ossification, 1 pronator syndrome and late radial nerve palsy, 1 radial head collapse and a DVT in the same patient and 1 with prominent hardware. Outcome scores were obtained on 11 patients at an average of 49 months (range 25 – 82 months) post-operatively. The average Quickdash score was 11 (range 0–43) and the average PREE score was 13 (range 0–34).

Conclusion: Monteggia IID fracture dislocations are complex injuries with a recurring pattern. Rigid anatomic fixation, early range of motion and avoidance of complications leads to a good outcome.

In the past, the treatment of acute elbow fracture-dislocations has emphasized repair to the medial collateral ligament (MCL), with favorable results. We report improved results using a strategy based on lateral-sided repair (lateral collateral ligament, radial head, coronoid) without MCL repair. In forty-seven patients, this strategy resulted in a high degree of success with no residual instability (valgus or otherwise). The dynamic stabilizers of the elbow activated through early postoperative motion, are important adjunct to stability. We have devised a reproducible radiographic method to demonstrate this. To review the surgical treatment of elbow dislocations without surgical MCL repair, and to determine if early active motion aids in restoring stability and concentric joint reduction. In the setting of acute fracture-dislocation of the elbow, concentric elbow stability with excellent functional results can be achieved using laterally-based surgical strategy without MCL repair. The dynamic stabilizers of the elbow, activated through the early motion, assist in providing joint congruity and stability. Forty-seven patients with acute elbow fracture-dislocations requiring operative treatment were treated at two university-affiliated teaching hospitals and evaluated an average of twenty-one months after injury. The protocol consisted of repair of the ulna and coronoid, repair or replacement of the radial head, and repair of the LCL, and early motion. The MCL was not routinely repaired. The LCL origin had been avulsed and reattached in all patients. One patient had a second procedure related to malpositioned radial head prosthesis. A stable mobile (average one hundred and one degree arc) articulation was restored in all patients. There was no evidence of valgus instability in any patient. Early motion was initiated at a mean of two weeks postoperatively. Postoperative ulnohumeral joint space opening improved from 4.9 ± 1.2 mm in the early postoperative period to 2.0 ± 0.5 mm (p < 0.00003) at final follow-up. We believe this is due to the effect of the dynamic stabilizers, which were allowed to function through early motion

Dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna have been referred to as the “terrible triad of the elbow” because of the difficulties in treating this injury and the poor outcomes. The orthopaedic database, Orthoscope, was used to identify all patients with dislocation of the ulnohumeral joint and fracture of both the head of the radius and the coronoid process of the ulna, seen and treated at Auckland City Hospital since 1998. All patients were invited to follow up appointments to evaluate the outcomes achieved. The research protocol was approved by the local research committee. Follow up appointments consisted of clinic al examination, assessing the range of elbow motion, an elbow radiograph and a functional assessment, using the DASH score and the American Shoulder and Elbow Society scoring systems. There were 32 patients identified, from Orthoscope, and invited for follow up. Six patients, who had moved overseas, were lost to follow up and two others declined follow up. 23 patients (24 elbows) remained for evaluation. All patients returned for the described assessment protocol. There were 10 male patients and 13 female patients, with a mean age of 46.9 (range, 29 to 67 years). The average arc of ulnohumeral motion was 122 degrees (range; 110 degrees to 140 degrees) and that of forearm rotation was 138 degrees (range, 35 degrees to 170 degrees). The radial head component was fixed in a standard fashion with repair, or replacement, and no radial head excisions were undertaken. Coronoid fractures were treated with screw fixation or suturing, with drill holes or anchors. To augment stability, a lateral ligament repair was undertaken in most patients. All patients, except one, would undergo the procedure again if needed. Elbow fracture-dislocations are historically very unstable and are prone to numerous complications. With operative treatment of the radial head, with repair or replacement, to restore stability through radiocapitellar contact, coronoid and lateral ligament repair, good range of movement and stability can be achieved

The August 2012 Shoulder & Elbow Roundup³⁶⁰ looks at: platelet-rich fibrin matrix and the torn rotator cuff; ultrasound, trainees, and ducks out of water; the torn rotator cuff and conservative treatment; Bankart repair and subsequent degenerative change; proprioception after shoulder replacement; surgery for a terrible triad, with reasonable short-term results; and the WORC Index.