The Journal of the Korean Society of Fractures Vol.11, No.3, July, 1998

Transcription

1 The Journal of the Korean Society of Fractures Vol11, No3, July, 1998 Department of Orthopaedic Surgery, College of Medicine, Gyeong-Sang National Univeristy, Chinju, Korea Post-traumatic elbow stiffness is a common and disastrous complication after acute elbow injury Prolonged immobilization universally leads to stiffness Stable fixation and controlled, gradual increase in range of motion is preferred for the treatment of comminuted intraarticular fracture and acute unstable dislocation of elbow In comminuted intraarticular fracture of elbow, the Compass Elbow Hinge provides additional stability for fixation devices used to fix intraarticular fractures and simultaneously permits measured and controlled joint mobilization In instability after reduction of elbow dislocation, the Compass Elbow Hinge helps to protect the soft tissue from undesirable stresses during healing The purpose of this study is to evaluate the results of the Compass Elbow Hinge in maintaining and restoring mobility in the acutely injured elbow The authors reviewed 11 consecutive patients who had the Compass Elbow Hinge applied for acute elbow instability The average duration of application was 7 weeks Follow-up averaged 18 months, and motion averaged 96 degrees in flexion/extension plane Concentric stability was restored in all but one case, one case of resubluxation required reconstruction of medial collateral ligament, following which, the elbow was stable According to the Mayo : 90 ( ) Tel : 0591) Fax : 0591)

2 710 elbow performance index there were 8 excellent, 2 good and 1 fair result The Compass Elbow Hinge helps to facilitate management of complex osseo-ligamentous injuries of the elbow It decreases the incidence of sequelae such as stiffness and instability by permitting early mobilization through a kinematically normal range of motion without jeopardizing soft tissue healing : Elbow fracture and dislocation, Compass Elbow Hinge , Compass Elbow Hinge 1 1, 11, 2, 1 2, 1 6, 2 6 ) 7, 4,, 44 ( ), 18 ( ) Compass Elbow 2, 4 ) 24 48Hinge 8, 16 ),, (passive manipulation), (dynamic splinting), ( C P M ), 27 ) 1-4,, 1 16 ) 1, 11 ) Gates 8 ) Compass Elbow Hinge 1 Compass Elbow Hinge 16 ), ( t r o c h l e a r ),,, 5, 16, Compass Elbow Hinge(Smith & Nephew ( c a p i t e l l u m ) ) 11 Richards Inc, Memphis, U S A) 7 ) (Fig 1A- C),, Compass Elbow Hinge

3 711 Anatomic location of the axis of elbow motion in the flexion - extension arc The lateral landmark is the tubercle at the site of origin of the lateral ligament which represents the geometric center of the capitellum The tilt of the axis is approximately 7-degrees of valgus with respect to the long axis of the humerus(cor : center of rotation) The medial location of the axis emerges at the antero-inferior aspect of the medial epicondyle which represents the center of the trochlea The center of rotation being confirmed under C-arm image intensifier control Anteroposterior and lateral diagrams showing the placement of humeral and ulnar half pins The proximal humeral half pin must be inserted perpendicular to the axis of humerus The distal humeral half pin is placed posteriorly, perpendicular to the axis of the humeral shaft The two ulnar half pins are also placed posteriorly perpendicular to the long axis of the ulna

4 712 Preoperative clinical photograph showing an open wound around the elbow Preoperative radiogram showing severely comminuted intercondylar fracture Open reduction and internal fixation was performed and Compass Elbow Hinge was applied Clinical photograph showing the application of Compass Elbow Hinge Lateral radiogram showing anatomic restoration of the anterior tilt of the distal humerus 16 ), ( t a r g e t ) (Fig 2), 5/8 Ilizarov 5/8 Ilizarov Compass Elbow Hinge (Fig 3A-B) Compass Elbow Hinge

5 713 Compass Elbow Hinge 4 m m 6, 5 5, R i s e b o r o u g h R a d i n 23 ) 4 5 4, 1 1, 4 16 ), Compass Elbow Hinge 7 ( 5-19 ) 3, 1, 2,,, Compass Elbow Hinge, 8, 3 Mayo Elbow Performance Index 19 ) 1 (Table 1) Mayo Elbow Performance lndex Function points Definition (Points) Pain 45 None (45) Mild (30) Moderate (15) Severe (0) Motion 20 Arc 100 degrees (20) Arc degrees (15) Arc 50 degrees (5) Stability 10 Stable (10) Moderate instability (5) Gross instability (0) Function 25 Comb hair (5) Feed (5) Hygiene (5) Shirt (5) Shoe (5) TOTAL 100 Classification : Excellent 90 ; Good ; Fair ; Poor ( ), 66 ( 0-76 ) 5 7 ( ) , 25 88, ,,, Mayo Elbow Performance Index 8, 2, 1 2, 1, 1 (Table 2)

6 714

7 715 1 ) Josefsson 12, 13 ), 16 ), 15 %,,, Tullos 26 ), 1, 9, 1 6 ) Mehlhoff 15 ) P r o t o z m a n 22 ) 34,, V o l k o v O r g a n e s i a n 28 ) Durig 6 ), Volkov O r g a n e s i a n Compass Elbow Hinge H o t c h k i s s 11 ) Compass Elbow Hinge Royle 24 ) 24, 37 C o b b M o r r e y 4 ) - 3 m m 5, 16-18, 21 ), Compass Elbow Hinge, Morrey 19 ), 11 ) Worm gear mechanism 100 ( ), 50, 15, 107, 1 Compass Elbow Hinge,, 1 4, 12, 13, 16, 21 ),

8 716,, C o m p a s s Compass Elbow Hinge Elbow Hinge, Compass Elbow Hinge,,,,, 7, 10, 13, 22 ), 7, 10, 13, 23 ) Riseborough R a d i n 23 ) 11 C o m p a s s, Helfet Elbow Hinge 20, S c h m e l i n g 10 ) 96 (70-130), 66 (0-76) 5 7 ( ) Compass Elbow Hinge,, Compass Elbow Hinge 14, 16 ) Compass Elbow Hinge Riseborough R a d i n 4 5, 1 - ( F i g 1) : 25, 88, 64 50, ,, 32 : C o o n e y 3 ), 4A-E), M a y o, 31: , ) : , ) Cooney WP : Contractures of the elbow In: Morrey

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