All the Secrets of Elbow Instability
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The goal of the present chapter is to have a comprehensive approach to instabilities of the elbow covering from how to diagnose and how to image them to how to treat them. Acute and chronic instability have different approaches and the presence of associated fractures (“complex instability”) influences the decision-making process. Surgical techniques will be reviewed covering with an emphasis on how to repair the lateral and medial ligament complex.
Instability of the elbow encompasses many different injuries that require extensive knowledge of anatomy of the elbow to guide proper physical examination and adequate imaging techniques. Proper physical examination has to be emphasized to gauge the clinical relevance of imaging findings. Simple radiographs remain the first imaging technique to rule out associated fractures. If a fracture is seen or highly suspicious, a CT scan can be helpful to define the magnitude of the fracture and the congruency of the ulnohumeral joint. Rarely, there will be a need for MRI in the acute setting.
The majority of simple elbow dislocations will do well after non-operative management. The addition of associated injuries will add severity to the instability and the need for a surgical intervention greatly increases. The goals of surgery will be to achieve stability and congruity of the joint. Most typically, complex injuries will require a stepwise surgical approach with adequate repair of the LCL complex, the coronoid, and radial head. In selected cases, replacement of the radial head is indicated.
Following these guidelines, a functional elbow will be achieved most of the time.
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