Fracture-dislocations of the elbow

Abstract

Fractures-dislocations of the elbow are complex and severe injuries with a high potential for complications and suboptimal or poor results. Careful physical exams and adequate imaging studies are essential to understand all injuries and provide satisfactory management. In the “terrible triad,” there is an elbow dislocation along with fractures of both radial head and coronoid process, leading to posterolateral rotatory instability. In these injuries, it is essential to treat the LCL tear and the radial head fracture. Coronoid fractures should be fixed in those cases with type II and III fractures which render the elbow unstable after radial head reconstruction. Varus posteromedial rotatory instability typically has both LCL tear and fracture of the anteromedial facet of the coronoid process, where the MCL attaches. The important aspect of the treatment is to repair the LCL and to fix the coronoid fragment. In transolecranon fractures-dislocations and complex Monteggia injuries, the principal damage lies on bony stabilizers. The standard of care is through precontoured plates and screws with careful assessment of any ligament tear, which will require adequate repair to prevent early failure of the implant or severe complications. An external fixator should be used in all cases with residual instability after appropriate treatment of these injuries. The principles of treatment are to provide a stable fixation of bone fragments and strong repair of ligaments to allow early range of motion to decrease the likelihood of elbow stiffness.