The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries



The purpose of this study is to evaluate the results of using a lateral hinged external fixator as an adjunct stabilizer in the treatment of a variety of acute destabilizing elbow injuries.


A retrospective review was performed on the medical records of patients in whom a lateral monolateral elbow hinged external fixator was applied by the senior author. The indication to apply the fixator corresponded to a variety of acute injury patterns ranging from simple elbow trauma or dislocation to complex fracture–dislocation, and the decision was based on either the presence of recurrent or persistent instability in any direction and/or to secure a vulnerable or weak bony fixation or soft tissue repair as intra-operatively judged by the surgeon. The fixator was inserted in the same setting after the repair of the associated ligamentous and/or bony structures. Patients operated after one month of the trauma and those presented with open elbow injury or associated humeral or ulnar shaft fracture were excluded. Rehabilitation was immediately started and the fixator removed at six to eight weeks with elbow testing and gentle manipulation under general anaesthesia, and resuming of rehabilitation after removal. Clinical assessment was performed for all patients according to the Mayo Elbow Performance Score (MEPS) with evaluation of range of motion at regular intervals till the end of the post-operative first year, then at final follow-up for the purpose of the study with radiographic assessment for evaluation of elbow reduction and concentricity.


There were 13 patients with a mean age of 42 years. Two patients had instability secondary to LCL rupture; one patient had redislocation because of associated coronoid process fracture; one patient had radial head fracture with rupture of both collateral ligaments; five patients had terrible triad injury with variable association of collateral ligaments lesions; and four patients had posterior Monteggia fracture–dislocation. The mean MEPS was 90 at a mean follow-up of seven years with six excellent, six good, and one fair result. All patients had a concentrically reduced and stable elbow as assessed clinically and radiologically with a mean functional arc of motion of 132° for extension–flexion and 178° for pronation–supination.


The hinged elbow external fixator represents a valuable adjunct in the therapeutic arsenal for the treatment of unstable elbows after bony and soft tissue repair. It provides satisfactory results in terms of stability and function and should be available in the operating room when a surgeon treats a complex elbow dislocation or fracture–dislocation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Ring D, Jupiter JB (1998) Current concepts review: fracture-dislocation of the elbow. J Bone Joint Surg Am 80-A:566–580

    Article  Google Scholar 

  2. 2.

    O'Driscoll SW, Jupiter JB, King GJW, Hotchkiss RN, Morrey BF (2000) The unstable elbow. J Bone Joint Surg Am 82-A:724–738

    Article  Google Scholar 

  3. 3.

    Broberg MA, Morrey BF (1987) Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res 216:109–119

    Google Scholar 

  4. 4.

    Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD (2004) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am 86-A:1122–1130

    Article  Google Scholar 

  5. 5.

    Sorensen AK, Sojbjerg JO (2011) Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation. J Shoulder Elb Surg 20:1300–1309

    Article  Google Scholar 

  6. 6.

    Tan V, Daluiski A, Capo J, Hotchkiss R (2005) Hinged elbow external fixators: indications and uses. J Am Acad Orthop Surg 13:503–514

    Article  Google Scholar 

  7. 7.

    Iordens GIT, Hartog DD, Van Lieshout EMM, Tuinebreijer WE, De Haan J, Patka P, Verhofstad MHJ, Schep NWL (2015) Good functional recovery of complex elbow dislocations treated with hinged external fixation: a multicenter prospective study. Clin Orthop Relat Res 473:1451–1461.

    Article  PubMed  Google Scholar 

  8. 8.

    McKee MD, Bowden SH, King GJ, Patterson SD, Jupiter JB, Bamberger HB, Paksima N (1998) Management of recurrent, complex instability of the elbow with a hinged external fixator. J Bone Joint Surg (Br) 80-B:1031–1036

    Article  Google Scholar 

  9. 9.

    Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71-A:1348–1354

    Article  Google Scholar 

  10. 10.

    von Knoch F, Marsh JL, Steyers C, McKinley T, O'Rourke M, Bottlang M (2001) A new articulated elbow external fixation technique. Iowa Orthop J 21:13–19

    Google Scholar 

  11. 11.

    Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 86–97

    Google Scholar 

  12. 12.

    Ring D, Jupiter JB (2002) Fracture-dislocation of the elbow. Hand Clin 18:55–63

    Article  Google Scholar 

  13. 13.

    O'Driscoll SW (2000) Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 370:34–43

    Article  Google Scholar 

  14. 14.

    Mehta JA, Bain GI (2004) Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg 12:405–415

    Article  Google Scholar 

  15. 15.

    Nestor BJ, O'Driscoll SW, Morrey BF (1992) Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 74-A:1235–1241

    Article  Google Scholar 

  16. 16.

    Ring D, Jupiter JB (2000) Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res 370:44–56

    Article  Google Scholar 

  17. 17.

    Hopf JC, Berger V, Krieglstein CF, Müller LP, Koslowsky TC (2015) Treatment of unstable elbow dislocations with hinged elbow fixation - subjective and objective results. J Shoulder Elb Surg 24:250–257

    Article  Google Scholar 

  18. 18.

    Bennett JB (1996) Unstable bony triad of the elbow. J Shoulder Elb Surg 5:S113

    Article  Google Scholar 

  19. 19.

    Hildebrand KA, Patterson SD, King GJW (1999) Acute elbow dislocations: simple and Complex. Orthop Clin N Am 30:63–79

    CAS  Article  Google Scholar 

  20. 20.

    Zeiders GJ, Patel MK (2008) Management of unstable elbows following complex fracture-dislocations—the “terrible triad” injury. J Bone Joint Surg Am 90-A Suppl 4:75–84.

    Article  Google Scholar 

  21. 21.

    Pizzoli A, Bondi M, Schirru L, Bortolazzi R (2019) The use of articulated external fixation for complex elbow trauma treatment. Musculoskelet Surg Published online 27 November 2019.

  22. 22.

    Cobb TK, Morrey BF (1995) Use of distraction arthroplasty in unstable fracture dislocations of the elbow. Clin Orthop Relat Res 312:201–210

    Google Scholar 

  23. 23.

    Madey SM, Bottlang M, Steyers CM, Marsh JL, Brown TD (2000) Hinged external fixation of the elbow: Optimal axis alignment to minimize motion resistance. J Orthop Trauma 14:41–47

    CAS  Article  Google Scholar 

  24. 24.

    Bigazzi P, Biondi M, Corvi A, Pfanner S, Checcucci G, Ceruso M (2015) A new autocentering hinged external fixator of the elbow: a device that stabilizes the elbow axis without use of the articular pin. J Shoulder Elb Surg 24:1197–1205.

    Article  Google Scholar 

Download references

Author information




A.H.C.: conception of the study, data analysis and interpretation, drafting and writing the article, and final approval of the version to be published.

A.H.A., M.J.H.R., A.A.D., H. M.W., and M.O. B: equal participation in data collection, data analysis, literature analysis, and final approval of the version to be published.

Corresponding author

Correspondence to Ali Hassan Chamseddine.

Ethics declarations

Ethical approval

The authors declare that the current study was approved by the Ethical Committee of their institution.

Participation consent

The authors declare that an informed consent was obtained from all patients to participate in the current study and that the data will be subject for publication.

Publication consent

The authors agree and give their consent to publish the current manuscript in “International Orthopaedics.”

Competing interests

The authors declare no competing interests.


The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of the current study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chamseddine, A.H., Asfour, A.H., Rahal, M.J.H. et al. The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries. International Orthopaedics (SICOT) (2021).

Download citation


  • Hinged elbow external fixator
  • Monteggia fracture–dislocation
  • Mayo Elbow Performance Score
  • Complex elbow dislocation
  • Terrible triad of the elbow