Review of Complex Elbow Injuries

Injury to the elbow from a fall, car accident, or direct trauma often results in fractures or dislocations. Dislocation with fracture or one or more bones can create an unstable elbow, a condition called complex elbow instability. Usually the ligaments around the elbow are also torn or damaged.

In this article, types of complex elbow injuries and their management are reviewed. The goal of treatment is to prevent recurrent dislocations and trauma-related arthritis. Patients need painless motion that allows them to complete daily tasks.

Surgery is often needed to manage difficult cases. For example, when the elbow won't stay in a reduced position (in the socket) then it may have to be pinned. Elbow joint replacement is used when fixation fails. The authors say that surgeons need a good understanding of elbow anatomy and treatment options to treat complex elbow problems. This article reviews both in detail.

Results of surgical management have improved over the years. Silicone implants have been replaced by titanium. Silicone joint replacements were better than removing the joint but there was a high failure rate. Studies show good long-term results with titanium. However, most patients aren't pain free and almost half develop signs of arthritis.

There's still a lot of debate about the best way to treat complex elbow fractures especially when combined with dislocations. Treatment within two weeks of the injury and early motion seem to give the best results. Recognizing when bony fragments need fixation to stabilize the joint is important.

References: Robert Z. Tashijian, MD, and Julia A. Katarincic, MD. Complex Elbow Instability. In Journal of the American Academy of Orthopaedic Surgeons. May 2006. Vol. 14. No. 5. Pp. 278-286.