Use Of The Internal Joint Stabilizer For Revision Elbow Surgery: A Multi-Center Retrospective Cohort Study
Reed W Hoyer, MD1; Roarke M Tollar, MS2
1Indiana Hand to Shoulder Center, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, IN
Background: The Internal Joint Stabilizer (IJS) is a relatively new device that has been shown to be effective for the treatment of terrible triad fracture dislocations of the elbow. There is limited data available regarding use of the IJS in revision surgery or injuries other that terrible triad fracture-dislocations. Here, we report the results of a cohort of patients treated using an IJS as an adjunct during revision surgery.
Methods: This study is a multi-center retrospective cohort study with prospectively collected patient reported outcomes (PROs) data performed at the Indiana Hand to Shoulder Center and the University of Cincinnati. All patients who underwent placement of an IJS for a revision surgical indication were included. Collected data included final elbow and forearm range of motion and complications collected from patient charts. Patient reported outcome scores including PREE, QuickDASH, and VAS were collected prospectively via a phone or video interview.
Results: 13 patients who met the inclusion criteria were identified. The average length of follow-up was 532 days. 12 patients had documented elbow ROM at final follow-up, which averaged 98 degrees. PROS were available in 10 patients. The QuickDASH averaged 38.6 and PREE averaged 36. The average VAS was 3.5. Fourteen post-operative complications occurred in 10 patients following placement of the IJS, for an incidence of 1.1/patient.
Conclusions: Revision elbow instability surgery remains a challenge despite the advent of the IJS. Use of the IJS in this setting results in a high complication rate and PROs and range of motion that are lower than those published for acute injuries. We urge caution when utilizing the IJS for revision surgical cases; these complex cases of instability may test the limits of the IJS, and alternative adjuncts like the external fixator might still be considered.
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