Instability of the elbow

During luxation of the elbow, significant injuries of the bones and soft tissue may occur. Uncomplicated luxation where a quick repositioning is performed mostly heals using conservative measures. If there is so significant damage that an immediate instability remains or if damage to the soft tissue is material, surgical stabilization is required.
Even after a conservative treatment, instability may remain which is expressed by the fact that the elbow actually luxates again or does not feel safe any more during certain movements or strains as those lead to subluxation and the arm "breaks away" or hurts.
If luxation has led to injuries to the bone, surgery is usually inevitable.

Fig. 69: Acute dislocation of the elbow.

Technique

Acute situation

After acute luxation encompassing soft tissue damage without any injury to the bone, the ligament structure is reconstructed laterally or medially depending on the damage location. If the outer or inner part is affected only, the skin may be cut either on the side concerned, or the classic posterior skin cut is performed. The tissue is examined and either fixed directly to the torn tissue part or, in case of tears from the bone, refixed to the bone using suture anchor systems.

Fig. 70: Suture repair of the lateral ligamenteous complex.

Chronic situation

In case of chronic instability, direct suturing of the soft tissue affected is no longer possible; an alternative procedure must be chosen. Similarly to the replacement plastics of the anterior cruciate ligament of the knee using the semitendinosus tendon, a transplant is grafted from the Palmaris longus tendon or from the posterior triceps tendon. Those transplants are then led through the original attachment points at the upper arm and forearm and fixed using bone tunnels or suture anchors.

Fig. 71: Example of a reconstruction of the lateral ligament at the elbow.

Fig. 72: Example of a reconstruction of the medial ligament of the Elbow.  

Surgery in case of injury to the bone

In case of additional bone fractures in the frame of luxation, those must be treated as well since the elbow joint is controlled mainly by the bones. Depending on the kind of injury, open osteosynthesis procedures with screws and plates at the ulna, radial bone and the distal humerus must be performed. Of particular significance is the Processus coronoideus which supports stability in extension. The radial head may also be injured in such material way that reconstruction is impossible; it must then be removed. The decision of whether to implant a radial head prosthesis depends on the remaining stability. If there is severe medial instability, such a prosthesis may be implanted as secondary stabilizer.

Fig. 73 a, b : X-ray before (a) and after implantation of a radial head prosthesis (b).

Follow-up treatment

As a rule, an elbow orthesis with limited scope of movement must be worn for 6 - 8 weeks. During this time, the joint is slowly mobilized under the guidance of a physiotherapist. In case of light physical work, the patient is able to work after 4 weeks; in case of heavy work, after 3 months at the earliest. Training is allowed only after 6 months.

Acute bone fractures

We are not an emergency practice, but feel free to contact us even with fresh bone fractures in the elbow joint area any time after giving notice by phone.

Movement restrictions

Movement restrictions may be caused by a variety of injuries and are treated using arthroscopic or open procedures.

Abb. 74 a, b : Massive limited range of movement after radial head fracture with herterotopic ossifications (a) and postoperative x-ray after open arthrolysis and resection of the radial head (b).