Unstable elbow dislocations

Seventeen patients with a posterior dislocation of the elbow and either no fracture or a minimal capsuloligamentous avulsion fracture were treated operatively for persistent redislocation after manipulative reduction. Fifteen had open reduction and ligament repair (3 with ancillary hinged external fixatin), and 2 infirm patients had closed reduction and cross pinning of the elbow joint. Among the 12 patients treated with ligament repair alone, 1 redislocated (treated with a second surgery for hinged external fixation) and 4 had residual subluxation (treated with temporary casting of protected active exercises) after ligament repair alone (42% residual instability). A concentric, stable elbow was eventually achieved in all 17 patients. The average flexion arc was 113 degrees. The average Broberg and Morrey score was 88, with 3 excellent, 10 good, and 2 fair results. A small percentage of elbow dislocations require operative treatment. Ligament repair alone may not be sufficient, and protection with a hinged external fixator is recommended.