Unique Indications for Internal Joint Stabilizer (IJS) for Elbow Instability
Riikka E Koso, MD, Luis Manuel Salazar, BSA and Anil K Dutta, MD, UT Health San Antonio, San Antonio, TX
Introduction: Treatment of elbow instability remains a challenge despite advancements in surgical techniques due to the conflicting goals of restoring elbow stability and regaining a good arc of motion. The objective of this study was to evaluate obesity, advanced age or frailty, and cognitive dysfunction (due to mental handicap, stroke, or traumatic brain injury) as unique indications for the use of the internal joint stabilizer in the treatment of elbow instability.
Materials and Methods: This was a retrospective review of all patients 18 years and older with elbow instability who were managed with an internal joint stabilizer (IJS) along with standard measures of care for their specific injury (such as fracture fixation or collateral ligament reconstruction). Patients were excluded if they did not have a minimum follow-up of 3 months. All patients were treated by a single shoulder and elbow fellowship-trained orthopedic traumatologist at an urban university-based Level 1 trauma center.
Results: Twenty-six patients were reviewed. Four were excluded for inadequate follow-up, leaving 22 patients in the study. Three patients were 60 years of age and older. Eight patients had a BMI of 30 or greater. Five patients had a history of one or more cerebral insults at the time of elbow injury. Complications included recurrent elbow instability (n=1), IJS failure without recurrent instability (n=1), and infection (n=2). Five patients did not undergo removal of the IJS. Four of these patients had healed but were lost to follow-up before IJS removal.
Conclusions: The IJS may be used to create elbow stability in complex patients, regardless of weight, frailty, or cerebrovascular insult. In comparison to the literature, external fixation for elbow instability has a much higher risk of infection and is more challenging for patients to take care of due to the weight and bulk of the external fixation frame. When considering internal or external fixation for elbow instability, the IJS may be preferable for the frail elderly, morbidly obese, or cognitively impaired.
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