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Chapter-23 Neglected Dislocation of the Elbow

BOOK TITLE: Neglected Musculoskeletal Injuries

Author
1. Mahaisavariya Banchong
ISBN
9788184488890
DOI
10.5005/jp/books/11171_23
Edition
1/e
Publishing Year
2011
Pages
8
Author Affiliations
1. Siriraj Hospital, Mahidol University, Bangkok-10700, Thailand, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chapter keywords

Abstract

Neglected unreduced dislocation of the elbow is rare and present as chronic fixed elbow dislocation, which are either undiagnosed or neglected. Unreduced dislocation less than 3 weeks old can be treated by closed reduction in most cases but those left unreduced more than 3 weeks usually required surgical treatment. However, most reports during past two decades have shown good results with functional range of motion after open reduction. It is reasonable that open reduction should be considered first for the treatment of neglected elbow dislocation. Other salvage procedure like excisional arthroplasty, fascial arthroplasty or elbow joint replacement should be considered only for cases with severely damaged articular surface. The author has described the pathological anatomy, common clinical feature of these neglected elbow dislocations. While performing open reduction the shortened triceps muscle must be lengthened. The fibrous tissue between distal humerus and ulna must be removed. The ulnar nerve should be decompressed in all patients. Most of the authors used K-wires for transfixing humerus and ulna or radial head and capitulum for 2-3 weeks. Arafiles described technique for creating intra-articular cruciates ligaments to stabilize the joint and allow early mobilization. Hotchkiss used hinged external fixator to maintain joint reduction, permit motion and enhance muscle tendon stretching.

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