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A Novel Internal Joint Stabilizer for the Elbow
Kristen M. Meier, MD; Steven M. Koehler, MD; Michael R. Hausman, MD
Mount Sinai Medical Center, New York, NY

Introduction: Treatment for elbow instability includes ligament repair/reconstruction and immobilization or external fixation. Consequently, the elbow is at risk for stiffness and instability. Ideally, after ligament repair/reconstruction patients should be able to immediately start range of motion. We describe and report findings in six patients treated with a novel internal joint stabilizer (NIJS).

Materials & Methods: This is a retrospective case series of six patients with posttraumatic instability treated with a NIJS created from bending and twisting a distal radius volar locking plate. The plate was fixed to the proximal ulna by locking screws and a partially threaded screw was placed through the axis of ulnohumeral rotation that allows for full range of motion.

Results: Six patients average age 44 (29-61) years, presented with posttraumatic elbow instability. Average follow-up was 15 (11-20) months. Two patients had acute, traumatic terrible triad elbow fracture dislocations. Three patients had chronic instability after the same injury and surgery at outside institutions. All elbows were clinically and radiographically stable intraoperatively and at last visit. During the index procedure, two elbows required tendon autograft for ligament reconstruction: one medial collateral ligament and one lateral ulnar collateral ligament. After the index procedure, the average arc range of motion was 67 44 degrees. Patients underwent a staged arthroscopic contracture release without removal of the NIJS. After this release, the average arc range of motion was 129 12 degrees. Two patients required a third procedure for removal of the NIJS due to hardware prominence. Three patients completed the DASH Questionnaire and the Mayo Elbow Performance Score (MEPS). The MEPS preoperatively were 30, 5, and 5. Postoperatively, the MEPS were 95, 85, and 50 respectively. The preoperative DASH scores were 94, 97, and 98. Postoperative DASH scores were 0, 6, and 73. Two patients achieved good or excellent results. One patient, who presented two years post injury after multiple surgeries continues to have poor overall scores although her function has improved greatly from baseline.

Discussion and Conclusion: Elbows with instability treated with an NIJS maintain stability and adequate range of motion at a mean follow up of 15 months. This device is easily made intraoperatively and permits immediate, postoperative range of motion while offering stability and protection of ligament repairs/reconstructions. Additional contracture release surgeries permit patients to quickly obtain full arc of motion without necessitating NIJS removal.

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