Static and Dynamic External Fixation are Equally Effective for Unstable Elbow Fracture-Dislocations.

OBJECTIVE To compare the clinical outcomes of static versus dynamic external fixation for elbow fracture-dislocations with persistent instability after surgical management. DESIGN Comparative, retrospective review. SETTING Two tertiary referral upper extremity centers. PATIENTS Twenty-four elbows requiring external fixation for persistent elbow instability within 90 days of surgical management of an elbow fracture-dislocation. INTERVENTION Static and dynamic external fixation was used in 16 and 8 patients for a median of 39 days (interquartile range, 33 to 48 days). MAIN OUTCOME MEASUREMENTS Elbow range of motion, complications, and revision surgeries. RESULTS Immediately following static and dynamic external fixation removal there was no difference in elbow extension (33°±16° vs. 41°±13°, mean difference (MD) 7°, 95% confidence interval (CI) -6° to 22°) or flexion (114°±35° vs. 118°±11°, MD 4°, 95% CI -23° to 132°), respectively. At last follow-up static and dynamic external fixation groups had no difference in elbow extension (27°±13° vs. 24°±10°, MD -3°, 95% CI -15° to 7°) or flexion (129°±12° vs. 128°±14°, MD -1°, 95% CI -13° to 10°), respectively. Static and dynamic external fixation groups had no difference in complications (7 (44%) vs. 5 (63%), difference 19%, 95% CI -23% to 54%) or revision surgeries (6 (38%) vs. 4 (50%), difference 13%, 95% CI -27% to 49%). CONCLUSIONS No difference in range of motion, complications, and revision surgeries was detected after static versus dynamic external fixation of persistently unstable elbow-fracture dislocations. Due to ease of application, static external fixation is our preferred treatment for these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.