209. CONTRIBUTION OF THE ARTICULATED EXTERNAL FIXATION FOR THE TREATMENT OF ELBOW INJURY: INDICATIONS AND RESULTS

Purpose of the study: The articulated external fixator of the elbow joint is often useful for the treatment of trauma victims. It can neutralise dislocation forces and protect osteosynthesis assemblies and ligament repairs while authorising early mobilisation. This work reports our indications and application of this type of fixator, as well as the expected clinical and radiographic outcomes. Material and methods: From 1995 to 2008, 34 patients had an external fixator of the elbow in our unit, in combination with classical treatment. Two groups of patients were distinguished, those with a traumatic injury requiring emergency care (n=15, group 1: six dislocations, two fracture-dislocations, and seven complex fractures), and those treated outside an emergency context (n=10, group 2: ten chronic dislocations or subluxations, four stiff joints, one infection, four material disassemblies). Eighteen patient were reviewed retrospectively, clinically and radiographically. The DASH score and the Mayo Elbow Performance Score (MEPS) were noted. The Broberg and Morrey classification was used for osteoarthritis. Results: At mean 4.3 years follow-up, for groups 1 and 2, the DASH scores were 35 and 25 points and the MEPS scores 74 and 74 points respectively. In group 1, the range of motion was 63° for flexion-extension; the elbow was centred and stable in all cases except 2 (one posterior subluxation). Six elbows presented moderate to severe osteoarthritis. In group 2, the range of motion was 80° flexion-extension; the elbow was centred and stable in all cases except one (one posterior subluxation). Moderate to severe osteoarthritis was noted in five elbows. There were four complications: two cases of transient (ulnar and radial) paralysis, one fracture of the humerus on a pin track, and one superficial pin track infection. Discussion: This study demonstrates that the articulated external fixation can maintain the reduction during the healing process for complex elbow trauma where stability is compromised. The morbidity is low and functional outcomes favourable. Early mobilization of these injured elbows can limit secondary stiffness. The prognosis remains a function of the initial injury and the quality of the associated treatments.