Skip to main content

External Fixation in the Setting of Elbow Instability

  • Chapter
  • First Online:
The Unstable Elbow

Abstract

The use of external fixators in the setting of elbow instability is a rare, but important tool in orthopedic surgeons’ armamentarium. They can be applied in a variety of clinical settings for added stabilization in the management of acute, complex, or chronic instability. Hinged external fixators offer the added benefit of early range of motion, but are technically difficult to place perfectly. Complications are common, and are mostly related to issues with pin sites. Future investigation is focused on minimizing complications and making hinged fixators easier to place on the center of axis of rotation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bible JE, Mir HR. External fixation: principles and applications. J Am Acad Orthop Surg. 2015;23(11):683–90.

    Article  PubMed  Google Scholar 

  2. Chen NC, Ring D. Terrible triad injuries of the elbow. J Hand Surg Am. 2015;40:2297.

    Article  PubMed  Google Scholar 

  3. Tan V, Daluiski A, Capo J, Hotchkiss R. Hinged elbow external fixators: indications and uses. J Am Acad Orthop Surg. 2005;13(8):503–14.

    Article  PubMed  Google Scholar 

  4. Tashjian RZ, Katarincic JA. Complex elbow instability. J Am Acad Orthop Surg. 2006;14(5):278–86.

    Article  PubMed  Google Scholar 

  5. Wyrick JD, Dailey SK, Gunzenhaeuser JM, Casstevens EC. Management of complex elbow dislocations: a mechanistic approach. J Am Acad Orthop Surg. 2015;23(5):297–306.

    Article  PubMed  Google Scholar 

  6. Chen NC, Julka A. Hinged external fixation of the elbow. Hand Clin. 2010;26(3):423–33. vii.

    Article  PubMed  Google Scholar 

  7. Stavlas P, Gliatis J, Polyzois V, Polyzois D. Unilateral hinged external fixator of the elbow in complex elbow injuries. Injury. 2004;35(11):1158–66.

    Article  CAS  PubMed  Google Scholar 

  8. London JT. Kinematics of the elbow. J Bone Joint Surg Am. 1981;63(4):529–35.

    Article  CAS  PubMed  Google Scholar 

  9. Deland JT, Garg A, Walker PS. Biomechanical basis for elbow hinge-distractor design. Clin Orthop Relat Res. 1987; (215):303-12.

    Google Scholar 

  10. Madey SM, Bottlang M, Steyers CM, Marsh JL, Brown TD. Hinged external fixation of the elbow: optimal axis alignment to minimize motion resistance. J Orthop Trauma. 2000;14(1):41–7.

    Article  CAS  PubMed  Google Scholar 

  11. Volkov MV, Oganesian OV. Restoration of function in the knee and elbow with a hinge-distractor apparatus. J Bone Joint Surg Am. 1975;57(5):591–600.

    Article  CAS  PubMed  Google Scholar 

  12. Stavlas P, Jensen SL, Sojbjerg JO. Kinematics of the ligamentous unstable elbow joint after application of a hinged external fixation device: a cadaveric study. J Shoulder Elbow Surg. 2007;16(4):491–6.

    Article  PubMed  Google Scholar 

  13. Iordens GI, Den Hartog D, Van Lieshout EM, Tuinebreijer WE, De Haan J, Patka P, et al. Good functional recovery of complex elbow dislocations treated with hinged external fixation: a multicenter prospective study. Clin Orthop Relat Res. 2015;473(4):1451–61.

    Article  PubMed  Google Scholar 

  14. Kamineni S, Ankem H, Patten DK. Anatomic relationship of the radial nerve to the elbow joint: clinical implications of safe pin placement. Clin Anat. 2009;22(6):684–8.

    Article  CAS  PubMed  Google Scholar 

  15. Carlan D, Pratt J, Patterson JM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg Am. 2007;32(8):1177–82.

    Article  PubMed  Google Scholar 

  16. Ring D, Bruinsma WE, Jupiter JB. Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability. Clin Orthop Relat Res. 2014;472(7):2044–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cohen MS, Hastings 2nd H. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998;6(1):15–23.

    Article  CAS  PubMed  Google Scholar 

  18. Charalambous CP, Stanley JK. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2008;90(3):272–9.

    Article  CAS  PubMed  Google Scholar 

  19. O’Driscoll SW, Morrey BF, Korinek S, An KN. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res. 1992; (280):186–97.

    Google Scholar 

  20. McKee MD, Bowden SH, King GJ, Patterson SD, Jupiter JB, Bamberger HB, et al. Management of recurrent, complex instability of the elbow with a hinged external fixator. J Bone Joint Surg Br. 1998;80(6):1031–6.

    Article  CAS  PubMed  Google Scholar 

  21. Ring D, Hannouche D, Jupiter JB. Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. J Hand Surg Am. 2004;29(3):470–80.

    Article  PubMed  Google Scholar 

  22. Sorensen AK, Sojbjerg JO. Treatment of persistent instability after posterior fracture-dislocation of the elbow: restoring stability and mobility by internal fixation and hinged external fixation. J Shoulder Elbow Surg. 2011;20(8):1300–9.

    Article  PubMed  Google Scholar 

  23. Arafiles RP. Neglected posterior dislocation of the elbow. A reconstruction operation. J Bone Joint Surg Br. 1987;69(2):199–202.

    CAS  PubMed  Google Scholar 

  24. Naidoo KS. Unreduced posterior dislocations of the elbow. J Bone Joint Surg Br. 1982;64(5):603–6.

    CAS  PubMed  Google Scholar 

  25. Billett DM. Unreduced posterior dislocation of the elbow. J Trauma. 1979;19(3):186–8.

    Article  CAS  PubMed  Google Scholar 

  26. Jupiter JB, Ring D. Treatment of unreduced elbow dislocations with hinged external fixation. J Bone Joint Surg Am. 2002;84-A(9):1630–5.

    Article  PubMed  Google Scholar 

  27. Orbay JL, Mijares MR. The management of elbow instability using an internal joint stabilizer: preliminary results. Clin Orthop Relat Res. 2014;472(7):2049–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bigazzi P, Biondi M, Corvi A, Pfanner S, Checcucci G, Ceruso M. A new autocentering hinged external fixator of the elbow: a device that stabilizes the elbow axis without use of the articular pin. J Shoulder Elbow Surg. 2015;24(8):1197–205.

    Article  PubMed  Google Scholar 

  29. Cheung EV, O’Driscoll SW, Morrey BF. Complications of hinged external fixators of the elbow. J Shoulder Elbow Surg. 2008;17(3):447–53.

    Article  PubMed  Google Scholar 

  30. Hopf JC, Berger V, Krieglstein CF, Muller LP, Koslowsky TC. Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results. J Shoulder Elbow Surg. 2015;24(2):250–7.

    Article  PubMed  Google Scholar 

  31. Ruch DS, Triepel CR. Hinged elbow fixation for recurrent instability following fracture dislocation. Injury. 2001;32 Suppl 4:SD70–8.

    Article  PubMed  Google Scholar 

  32. Papandrea RF, Morrey BF, O’Driscoll SW. Reconstruction for persistent instability of the elbow after coronoid fracture-dislocation. J Shoulder Elbow Surg. 2007;16(1):68–77.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph A. Abboud MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Aleem, A.W., Ramsey, M.L., Abboud, J.A. (2017). External Fixation in the Setting of Elbow Instability. In: Tashjian, R. (eds) The Unstable Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-46019-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46019-2_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46017-8

  • Online ISBN: 978-3-319-46019-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics