Chronic Elbow Instability: Is Treatment Effective?

ABSTRACT

Since 1990, six patients have been treated at our institution for chronically subluxated or dislocated elbows. Four of six patients presented after initial treatment for simple elbow dislocations, which required operative reduction and casting due to marked instability. These four patients redislocated while casted and were subsequently referred to our institution. No obvious fractures were noted in any patient.

After proper evaluation with plain radiographs, magnetic resonance imaging, or both, each patient underwent operative intervention. The technique used ranged from lateral ulnar lateral collateral ligament reconstruction to lateral and medial collateral ligament reconstructions. The procedure used was based on whether instability persisted after reconstruction of the lateral corner of the elbow. All patients were placed in hinged external fixation to maintain reduction during healing. Average follow-up was 3.3 years.

Long-term evaluation indicated that four of six reconstructions remained stable radiographically. One patient continued to show evidence of subluxation radiographically, although functioned well and was satisfied with the ultimate outcome. The final patient redislocated and ultimately required a total elbow arthroplasty.

Chronic elbow instability is an extremely difficult clinical situation. Unfortunately, no treatment algorithm exists and each case must be individualized. We believe treatment beginning with the lateral corner of the elbow and progressing to the medial corner of the elbow, if necessary, is an effective method to maintain long-term elbow stability. Based on our results, proper treatment can be effective in the majority of cases.