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ELBOW DISLOCATION WITH INTRA-ARTICULAR FRACTURE: THE RESULTS OF OPERATIVE TREATMENT WITHOUT REPAIR OF THE MEDIAL COLLATERAL LIGAMENT

Dr Rafia Sarwar,Dr Iqra Azam, Dr Mahnoor Amin

Abstract: Aim: To determine the effectiveness of a protocol for the treatment of fracture-dislocations of the elbow based on the concept that, if dislocation of the elbow with associated fractures can be made to resemble a simple elbow dislocation by repairing or reconstructing the fractured structures, repair of the medial collateral ligament (MCL) will not be necessary. Methods: 34 patients with a posterior dislocation of the elbow associated with one or more intra-articular fractures were selected. The mean age of these 19 men and 15 women was 48 years. Associated fractures included the capitellum, trochlea, and lateral epicondyle in 3 patients; the olecranon in 1 patient; and the radial head in 30 patients (with concomitant fracture of the coronoid process—the so-called “terrible triad” of the elbow—in 22 patients, and concomitant fracture of the coronoid and olecranon in 1 patient). Operative treatment consisted of open reduction internal fixation (ORIF) or prosthetic replacement of all fractures and reattachment of the origin of the lateral collateral ligament (LCL) complex to the lateral epicondyle. The MCL was not repaired. Results: Two patients had postoperative instability related to noncompliance, had reconstructive procedures, and were considered failures. An average of 32 months after injury, the remaining 32 patients regained an average of 120° ulnohumeral motion and 142° forearm rotation. Twenty-five of 34 patients (74%) had good or excellent results according to the system of Broberg and Morrey. Patients with terrible triad injuries had an average of 117° ulnohumeral motion and 137° forearm rotation, and 17 of 22 patients (77%) had good or excellent results. Conclusions: MCL repair is unnecessary in the treatment of dislocation of the elbow with associated intra-articular fractures, provided that the articular fractures and the LCL are repaired or reconstructed.

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