Elbow Joint Stabilization

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Evolution of Elbow Joint Stabilization

Historically, several methods of temporary stabilization have been utilized to manage chronic elbow instability. First line option involved immobilization of the elbow joint with the use of a splint or cast with the elbow in flexion a period of time sufficient for the soft tissue stabilizers to either heal or scar down (typically for a matter of several weeks).

This method was notoriously ineffective for a couple reasons. The first is that the arbitrarily flexed position of the elbow may not actually be in a position of stability. The second is that the elbow joint becomes stiff very rapidly in a matter of days, far quicker than the time required for the soft tissues to heal enough to provide adequate stability.

The surgical option in the past involved transarticular pinning (a metal pin placed across the elbow joint preventing motion). The drawback to this method is damage to the articular surface of the joint, which predisposes patients to early on set osteoarthritis.

This led to the use of external fixators, which involve metal pins inserted through the skin and into the bone both above and below the elbow joint. These pins are then connected to rods on outside of the skin. The use of hinged external fixators has been advocated, but due to difficulty of appropriately aligning the axis of rotation, preventing stiffness with early range of motion often was unsuccessful.

This led to abandoning the hinged component of the external fixator and acceptance of significant elbow stiffness. This is still often used in today’s practice, but these come at the cost of preserving joint motion, are clumsy, and pin tract infections are very common.

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