Využití zevní fixace v ortopedii a traumatologii lokte

FERANEC, Martin, Radek HART and T. KOZÁK. Využití zevní fixace v ortopedii a traumatologii lokte (Hinged External Fixation in Orthopaedic and Trauma Surgery of the Elbow). Acta chirurgiae orthopaedicae et traumatologiae Čechoslovaca. Praha: Galen, 2013, vol. 80, No 6, p. 391-395. ISSN 0001-5415.

Basic information

• Original name: Využití zevní fixace v ortopedii a traumatologii lokte
• Name (in English): Hinged External Fixation in Orthopaedic and Trauma Surgery of the Elbow
• Authors: FERANEC, Martin (703 Slovakia, belonging to the institution), Radek HART (203 Czech Republic, guarantor, belonging to the institution) and T. KOZÁK (203 Czech Republic).
• Edition: Acta chirurgiae orthopaedicae et traumatologiae Čechoslovaca, Praha, Galen, 2013, 0001-5415.

Other information

• Original language: Czech
• Type of outcome: Article in a journal
• Field of Study: 30211 Orthopaedics
• Country of publisher: Czech Republic
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 0.415
• RIV identification code: RIV/00216224:14110/13:00071239
• Organization unit: Faculty of Medicine
• UT WoS: 000329549900004
• Keywords in English: external fixator of the elbow; stable fixation; early rehabilitation; MEP score
• Tags: International impact, Reviewed

Abstract

Kloubový zevní fixátor (ZF) loketního kloubu má podstatný význam v řešení komplikujících poranění lokte (7). Dovoluje časný pohyb, přitom chrání kloub a periartikulární struktury od nadměrného násilí (19), což je jeho primární terapeutický cíl. Když je správně aplikován, udržuje v rovnováze kloub během pohybu a chrání rekonstruovaná ligamenta (12). U lokte, více než u kteréhokoliv jiného kloubu, je třeba dodržovat při ošetření úrazů základní zásady AO. Jednou z nich je časná mobilizace. Po operaci, resp. úrazu začínáme s rehabilitací na našem oddělení vždy do 6 dnů (prevence ztuhlosti). Úspěch použití zevní fixace je závislý na přesném umístění osy otáčení fixátoru v ose rotace kloubu, což je nejkritičtějším krokem aplikace aparátu. Cílem studie bylo prezentovat naše zkušenosti a možnosti využití zevního fixátoru loketního kloubu, přiblížit operační techniku aplikace zevního fixátoru a vyhodnotit skupinu pacientů, u které byl užit kloubový zevní fixátor pro těžká poranění lokte, a to traumatickou nestabilní luxaci, luxační nestabilní zlomeniny, zlomeniny v oblasti loketního kloubu s nemožností primární osteosyntézy, posoudit efekt časné mobilizace a porovnat skupinu pacientů s poraněním loketního kloubu léčených konzervativně sádrovou dlahou s následnou rehabilitací.

Abstract (in English)

PURPOSE OF THE STUDY A hinged external fixator of the elbow provides stable fixation of the joint while maintaining the range of its motion. The aim of the study was to evaluate a group of patients in whom an external fixator was used to manage severe injuries to the elbow, namely, traumatic unstable dislocation, unstable fracture-dislocation, and elbow fractures not permitting management by primary osteosynthesis. This also involved assessment of early elbow mobilisation and a comparison of this group with a group of patients treated conservatively for less severe elbow injuries. MATERIAL AND METHODS A group of 25 patients were evaluated at a follow-up of 18 months. There were 10 women and 15 men; the average age was 48 years (range, 20 to 76). The external fixator was applied in 13 patients, of whom eight had unstable elbow dislocation, three had unstable fracture-dislocation and two suffered a comminuted supracondylar fracture of the distal humerus. The hinged fixator was removed at an average of 7.6 weeks (range, 3 to 9 weeks). In the group of 12 patients treated conservatively by plaster cast application and subsequent rehabilitation, five had elbow dislocation without ligament injury and seven had elbow dislocation with ulnar collateral ligament injury. None of them showed any instability. The patients were evaluated on the basis of clinical and radiological findings, with the Mayo elbow performance (MEP) score being used for clinical assessment. RESULTS At a follow-up of 18 months, the patients with the external fixator showed the average range of motion at the elbow joint of 127 (105 to 140), the MEP score of 92 points (75 to 100) and restriction of elbow extension by 8 (0 to 40). In the conservatively treated patients, the range of motion was 133 (112 to 145), the MEP score was 95 points (85 to 100) and extension restriction by 8 (0 to 22). X-ray examination showed a congruent joint in both groups. The use of external fixator was associated with minor complications: transient radial nerve irritation in one case, and pin-tract infection in two cases (23%) which healed spontaneously after screw removal. DISCUSSION The optimal management of a complex elbow injury should results in restoring joint stability and its full range of motion. However, this is often difficult to achieve by surgical means and a marked restriction of movement remains a frequent consequence of severe elbow injury. CONCLUSIONS Elbow injuries differ from patient to patient and therefore the approach to their treatment has to be individual in every patient. A hinged external fixator provides stable fixation and allows for early movement of the elbow. Maintenance of the range of motion facilitated by the hinged fixator is not at the expense of joint stability or fracture non-union. Based on the results presented here, we recommend the use of external fixation in severe unstable elbow fractures and in fractures in which primary osteosynthesis cannot be used because of soft tissue injury.