Complications of hinged external fixators of the elbow

doi:10.1016/j.jse.2007.10.006

Journal of Shoulder and Elbow Surgery

Volume 17, Issue 3, May–June 2008, Pages 447-453

https://doi.org/10.1016/j.jse.2007.10.006 Get rights and content

Despite the growing use of hinged external fixators of the elbow, there are no studies regarding the complications associated with their application. The purpose of this study is to report our experience with complications with this procedure. Between 1998 and 2005, we reviewed the records of 100 consecutive patients who were treated with hinged external fixators (including 433 pin sites). Complications specifically related to pin placement were recorded. There were 15 patients with minor complications (15%) involving 21 pins (4.8%) and 10 patients with major complications (10%) involving 29 pins (6.7%). Minor complications included local erythema and nonpurulent drainage lasting greater than 5 days in 9 patients (21 pins) and the need for skin release to decrease tension adjacent to pins in 6 patients (9 pins). Major complications included purulent pin site drainage in 1 patient (2 pins), fixator malalignment in 1, pin loosening in 4 (11 pins), and deep infection in 4. There were no fractures around the pin sites or nerve injuries associated with pin placement. With care, articulated external fixators can be used without a high incidence of major complications. Most of the complications were attributed to local pin site infection. Factors clinically associated with an increased risk of deep infection include a history of prior procedures in the post-traumatic elbow and the complexity of the operative technique.

Section snippets

Materials and methods

Between June 1998 and November 2005, 100 consecutive elbows in 100 patients had placement of a hinged external fixator about the elbow at our institution by 2 surgeons. Patients who sustained Gustilo grade III or more severe soft-tissue injury and those with open fractures at the time of the placement of the external fixator device were excluded from this study. The Dynamic Joint Distractor II (DJD II) device (Stryker Orthopaedics, Mahwah, NJ) was used in 80 elbows (Figure 1), and the Compass

DJD II

There were a total of 80 patients with 320 pins in the DJD II group. There were 36 female patients and 44 male patients. The median age for this group was 42 years (range, 14-78 years). Of the 80 patients, 60 (75%) received a course of postoperative prophylactic oral antibiotics. The underlying diagnosis was rheumatoid arthritis in 9 patients, post-traumatic arthritis in 53, acute injury with associated instability in 12, and congenital anomaly in 5 (Table I). Procedures associated with

Discussion

There have been a small number of case reports, but no comprehensive assessment has documented pin site complications of placement of articulated external fixators about the elbow. Problems incidentally noted in these reports included purulent discharge, osteolysis, or pin hole osteomyelitis.3, 7 The rate of pin tract–related complications has been reported as 4.4%.³

In the early experience with hinged external fixators of the elbow, as with the predecessor of the DJD II device, the DJD I

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There are more references available in the full text version of this article.

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Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS.
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Complex unstable elbow fracture dislocations can be a challenging pathology to treat for orthopedic surgeons. Historical treatment methods of persistent elbow instability after bony and ligamentous pathology have been addressed include prolonged immobilization, trans-articular pinning, and static or hinged external fixators. However, they can be associated with significant complications and unacceptable rates of unsatisfactory clinical outcomes. As a result, a movable internal fixator known as an internal joint stabilizer (IJS) was developed to help mitigate these complications. The IJS, when utilized, often is inserted at the origin of the lateral ulnar collateral ligament (LUCL). The rotating humeral pin of the IJS must be placed in the elbow’s center axis of rotation at the distal humerus to function properly. The competition for the same footprint makes concomitant anatomic repair of the LUCL challenging. This paper seeks to describe a surgical technique that allows for isometric humeral pin placement of the IJS without sacrificing the ability to restore the LUCL to its anatomic footprint by combining the LUCL suture anchor and IJS humeral pin sites.
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Original articleComplications of hinged external fixators of the elbow

Section snippets

Materials and methods

DJD II

Discussion

Hand Clin

J Hand Surg [Am]

J Hand Surg [Am]

Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty

J Bone Joint Surg Br

Use of distraction arthroplasty in unstable fracture dislocations of the elbow

Clin Orthop Relat Res

Original article
Complications of hinged external fixators of the elbow