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IJS: Internal Joint Stabilizer. Elbow Complex Cases
Jorge Luis Orbay, MD; Igor R. Indriago
The Hand Institute, Miami, FL

Introduction: Complex Elbow instability is a combination between a fracture, ligamentous injury, subluxation or dislocation of the joint components. The elbow treatment pathologies require a technically demanding balance between stability and ROM preservation. Different osseous-ligamentous patters of injury, like fracture of radial head, coronoid and olecranon fracture, injury to collateral ligaments and other soft tissue restrains lesions, make more difficult the orthopedic/hand surgeon job. Preserve stability and range of motion after reconstructive Elbow fractures-ligamentous injury procedures is our goal.

Methods: We performed a retrospective review of all the cases treated between 2008 and 2009 with Elbow Internal Joint Stabilizer, (EIJS by Skeletal Dynamics). Indication for this procedure was: in acute cases, fractures of any osseous components and ligaments/soft tissues injuries, or severe ROM limitation or unstable elbow after some Elbow surgery. The elbow fracture components was fixed using different procedures and surgical materials in acute cases, on previous surgery cases, revision of the all osseous components, surgical material removal when is necessary and reconstruction of the collateral ligaments was performed. The more important surgery key is the location of the distal lateral humerus isometric point, located 2 mm proximal to the center of the capitellum. Cast/splint is used for 4 weeks. Elbow function was allowed after cast/splint removal and no further support was provided. During follow-up visits results were evaluated by ROM (Flexion/Extension, Pronation/Supination), joint stability and grip strength.

Results: Of out of 10 patients who underwent the procedure in this interval, 10 were followed for a minimum of 12 months, 5 was acute, 4 had a previous surgery and 1 had AR. At their final follow-up all patients were satisfied with their degree of ROM. Average Range of motion: flexion 120, extension -10, Pronation 75, Supination 60, Jamar strength averaged 40% of the non-operated site. The employed patients were able to return to full work at an average of 12 weeks. Complications were some pain or sensibility located on the skin over the hardware location, we recommended removal of hardware; there were no non-unions, loss of correction or subluxation.

Conclusion: The treatment of cases with previous surgery with rigid/unstable elbow or the treatment of unstable elbow after fractures with an internal joint stabilizer is possible with the use of the EIJS. This device provides stable elbow joint and allows early function and presents a low complication rate and minimizes instability joint problems.

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