Salazar Luis M, Kanawade Vaibhav, Prabhakar Gautham, Julian Bao-Quynh, Brennan Jacob, Smith Matthew, Momtaz David A, Dutta Anil K
Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, UT Health San Antonio, San Antonio, TX, USA.
JSES Rev Rep Tech. 2022 Mar 11;2(2):219-229. doi: 10.1016/j.xrrt.2022.02.001. eCollection 2022 May.
The main goal of treatment for chronically unreduced elbow dislocations is to restore a stable, concentric joint and regain a satisfactory arc of motion. Due to the conflicting goals of restoring elbow stability and regaining a good arc of motion, the treatment of chronic elbow dislocation remains a challenge for even the experienced orthopedic surgeon. The standard treatment of these dislocations consists of open reduction, V-Y muscleplasty of the triceps, and temporary arthrodesis or cast immobilization. However, prolonged postoperative immobilization may result in elbow stiffness, which significantly limits the functional outcome. We present our surgical technique with a focus on restoring stable reduction such that early motion can be instituted and complications of prolonged immobilization can be avoided. From position to wound closure, surgical steps are presented in detail, with pearls for practice and a discussion on chronic elbow dislocation. The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations. This reproducible surgical technique allows for stability and early mobility while having the added benefit of circumventing complications associated with prolonged immobilization and hinged external fixation. Understanding the surgical indications, as well as the nuances of the surgical technique utilizing the internal joint stabilizer, is critical in order to improve patient outcomes and avoid complications.
慢性肘关节脱位治疗的主要目标是恢复稳定的、同心的关节并重新获得满意的活动弧度。由于恢复肘关节稳定性和获得良好活动弧度这两个目标相互冲突，即使是经验丰富的骨科医生，慢性肘关节脱位的治疗仍然是一项挑战。这些脱位的标准治疗包括切开复位、肱三头肌V-Y肌成形术以及临时关节固定术或石膏固定。然而，术后长期固定可能导致肘关节僵硬，这会显著限制功能预后。我们介绍我们的手术技术，重点是恢复稳定的复位，以便能够早期活动并避免长期固定的并发症。从体位到伤口缝合，详细介绍了手术步骤，提供了操作要点并讨论了慢性肘关节脱位。关节内稳定器是一种安全有效的植入物，可辅助慢性肘关节脱位的治疗。这种可重复的手术技术可实现稳定性和早期活动，同时还有避免与长期固定和铰链式外固定相关并发症的额外益处。了解手术适应症以及使用关节内稳定器的手术技术细节，对于改善患者预后和避免并发症至关重要。
