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A Systematic Review Examining the Clinical Evidence for the Elbow Internal Joint Stabilizer
Preksha Rathod, MD
1; Diego Martinez Leyton, MD
2; Khaled Al Awadhi, MD
3; Ali Lari, MD
4; Carlos Prada, MD, MSc
11McMaster University, Hamilton, ON, Canada; 2Hospital of the Worker Santiago, Santiago, Región Metropolitana, Chile; 3New Jahra Hospital, Al Jahra, Al Jahra, Kuwait; 4Al Razi Orthopedic Hospital, Kuwait City, Kuwait City, Kuwait
Introduction: Elbow instability remains a challenging entity to manage due to the complex anatomy of the elbow joint. Historically, it has been managed by interventions such as ulnohumeral cross pinning or external fixation which are associated with various complications. Recently, an internal joint stabilizer (IJS) has been introduced to allow early range of motion while stabilizing the elbow. This review examines the literature pertaining to the IJS, its safety profile, and outcomes.
Methods: A systematic review of studies published in MEDLINE, EMBASE, Web of Science and CINAHL was conducted to assess the operative outcomes of the IJS. Data on patient demographics, indications for use, postoperative outcomes, complications, and implant removal were compiled. Statistical analysis was not conducted.
Results: Nine retrospective studies met the inclusion criteria. 171 patients with a mean age of 48.2 years were included in the analysis. There were 141 cases of acute instability and 29 cases of chronic instability (Figure 1). The average outcome measures were DASH of 22 and MEPS of 82. Predominant complications included hardware-related complications, heterotopic ossification, and nerve injury leading to an average complication rate of 36.2% and a 24% reoperation rate (Table 1). The average time to removal was 11.8 weeks with 75% of patients having implant removal.
Conclusion: - Currently no agreement in literature on whether the IJS is more effective in chronic or acute cases, though this study shows the majority of use in acute instability
- The device restored functional range of motion in 61.2% of patients, however a significant portion experienced stiffness despite early range of motion training
- While the IJS shows promise for treating elbow instability with good functional outcomes and patient reported satisfaction, concerns arise from its high complication and re-operation rates (36.2% and 24% respectively), and the substantial portion of patients not achieving functional range of motion
- The benefit of the IJS compared to counterparts remains unclear; Careful deliberation is needed regarding risks, benefits and cost prior to utilizing the IJS
- Quality of research pertaining to the use and safety profile of the IJS is poor, highlighting the necessity for further research to clarify its role
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