JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2016, Vol. 54 ›› Issue (12): 41-45.doi: 10.6040/j.issn.1671-7554.0.2016.228

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A standard surgical protocol and outcome of treating varus posteromedial rotational instability of elbow

LIU Tao, BAO Feilong, GAO Wei, KANG Shijie, LÜ Fuxin, HU Yiming   

  1. Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao), Qingdao 266035, Shandong, China
  • Received:2016-02-28 Online:2016-12-10 Published:2016-12-10

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Abstract: Objective To explore a standard surgical protocol and observe the clinical outcomes of treating varus posteromedial rotational instability(VPRI)of the elbow. Methods A total of 15 VPRI cases surgically treated via the medial and lateral approach during Dec. 2011 and Nov. 2014 were involved, including 9 males and 6 females, aged 11 to 69 years, mean 35.6 years. Altogether 7 left and 8 right elbows were affected. Causes of injury included traffic injury in 1 case and fall on the ground from the standing position in 14 cases. O Driscoll classification showed 9 cases of type Ⅱ1, 5 cases of type Ⅱ2 and 1 case of type Ⅱ3. The elbow stability and the humeroradial joint space were assessed by applying varus, pronated and axial stresses onto the forearm under fluoroscopy after anesthesia pre-, intra- and postoperation. The fractures of the coronoid were fixed with mini-plates or special designed plates, combined with K-wires or lasso sutures when fracture comminuted or extended to tip, via the medial approach, then lateral Kocher approach was performed, and lateral collateral ligament(LCL)was repaired using suture anchors. No external fixator was used. Rehabilitation program was early initiated with the guidance of surgeons after operation. Results All cases were followed-up for 12 to 30 months(average 18.7 months). Bony union was achieved in all cases within 7 to 14 weeks, with an average of 10 weeks. The average flexion was(136.8°±3.3°), average extension(3.6°±1.3°), average pronation(86.8°±5.6°), average supination(88.6°±3.5°). No complications such as elbow instability, pain and cubitus varus occurred. According to the Mayo elbow performance score(MEPS), the results were excellent 山 东 大 学 学 报 (医 学 版)54卷12期 -刘涛,等.肘关节内翻后内侧旋转不稳的手术疗效 \=-in 13 cases and good in 2 cases. The mean DASH(disabilities of the arm, shoulder and hand)score was 5.3(2.5 to 12.5). Conclusion Using standard surgical protocol for elbow varus posteromedial rotational instability can restore sufficient elbow stability to allow early motion, enhance the functional outcome, and reduce the overall complications such as cubitus varus, early degenerative changes and instability.

Key words: Elbow joint, Coronoid process, Anteromedial facet, Surgical treatment, Instability, Fracture

CLC Number: 

  • R684.7
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