Management of recurrent, complex instability of the elbow with a hinged external fixator

We have treated 16 patients with recurrent complex elbow instability using a hinged external fixator. All patients had instability, dislocation or sub luxation of the ulnohumeral joint. The injuries were open in eight patients and were associated with 20 other fractures and five peripheral nerve inju ries. Two patients had received initial treatment from us; 14 had previousl y had a mean of 2.1 unsuccessful surgical procedures (1 to 6). The fixator was applied at a mean of 4.8 weeks (0 to 9) after the injury and remained o n the elbow for a mean of 8.5 weeks (6 to 11). After treatment we found the mean range of flexion-extension to be 105 degrees (65 to 140). At a final follow-up of 23 months (14 to 40), the mean Morrey score was 84 (49 to 96): this translated into one poor, three fair, ten good and two excellent resu lts. Complications included one fractured humeral pin, one temporary palsy of th e radial nerve, one recurrent instability, one wound infection, one severe pin-track infection and one patient with reflex sympathetic dystrophy. Alth ough technically demanding, the use of the fixator is an important advance in the management of recurrent complex elbow instability after failure of c onventional treatment.