Elbow Instability in Children

Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA 94143, USA.
Hand Clinics (Impact Factor: 1.26). 03/2008; 24(1):139-52. DOI: 10.1016/j.hcl.2007.11.007
Source: PubMed


Instability in the pediatric elbow can be secondary to trauma, developmental disorders, congenital anomalies, inherited disorders, or acquired systemic processes. The pediatric elbow presents unique challenges with regard to open growth plates, propensity for dislocation and spontaneous reduction, and increased time for the development of post-traumatic deformity into adulthood. The purpose of this article is to review current concepts of injuries leading to elbow instability, discuss how to recognize and treat the instability, and address other, nontraumatic causes of elbow instability.

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    ABSTRACT: Posttraumatic instability of the elbow in children can be a very challenging problem to diagnose and treat. Posterolateral rotatory instability (PLRI) has been well described with regard to diagnosis and treatment in adults but best clinical practices are less clear for pediatric cases. Children with PLRI can present with unusual signs and symptoms and poorly documented, vague trauma. The need for and safety of formal reconstruction of the lateral ulnar collateral ligament in children has been somewhat controversial in the past; however, with careful consideration the diagnosis of PLRI in children can be recognized and successfully treated with ligamentous repair or reconstruction. This report presents an overview of the current practice in the diagnosis and treatment of PLRI in the pediatric population. Indications for surgical treatment and step-by-step surgical instructions for both ligamentous repair and reconstruction are presented.
    No preview · Article · Jun 2010 · Techniques in hand & upper extremity surgery
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    ABSTRACT: In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open reduction-Internal fixation of the fracture dislocation and ulnar nerve exploration were performed under general anesthesia at the same session as surgical treatment of our patient. Physical therapy and rehabilitation protocol was implemented at the end of two weeks post-operatively. Union of the fracture lines, as well as the olecranon osteotomy site, was achieved at the end of four months post-operatively. Ulnar nerve function was fully restored without any sensory or motor loss. Range of motion at the elbow joint was 20-120 degrees at the latest follow-up.
    Full-text · Article · Apr 2013 · World Journal of Orthopaedics
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    ABSTRACT: Posterolateral rotatory instability is a type of ulnohumeral instability seen following elbow trauma. It is caused by a deficiency in the lateral collateral ligament complex that allows the radius and ulna to subluxate as a single unit with respect to the distal part of the humerus. There are few studies on this type of instability in children. Our purpose was to evaluate cases of posterolateral rotatory instability in children to better understand its presentation and manifestation as compared with those in adults. This was a retrospective chart review of patients from three academic centers. Eligible for inclusion were patients with a diagnosis of posterolateral rotatory instability who were treated with lateral ulnar collateral ligament reconstruction when they were less than nineteen years of age. Nine patients met the inclusion criteria. The mean age at the initial injury was ten years, and the average time from the initial injury to the final operation was 3.7 years. Six patients had prior elbow dislocation, and three had an isolated elbow fracture. Six of the nine patients had a forearm or elbow contracture. Only one patient had a positive pivot-shift test during the preoperative office examination, but all had a positive pivot-shift test when examined under anesthesia. Six had radiographic evidence of posterolateral rotatory instability. All patients underwent lateral ulnar collateral ligament reconstruction. At the time of follow-up, at a minimum of one year after the ligament reconstruction, there was no evidence of deformity secondary to early physeal closure and all elbows remained stable. Although posterolateral rotatory instability of the elbow is rare, it does exist in children. The instability may not always be recognized because of masking by contracture but, as is the case with adult patients, radiographs may show evidence of the instability. In children with contracture, the clinician should consider the possibility of a masked posterolateral rotatory instability and plan accordingly at the time of contracture release. Surgical correction is technically difficult, and traditional ligament reconstruction in skeletally immature patients may pose a risk to the lateral humeral condylar and epicondylar physes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    No preview · Article · Aug 2013 · The Journal of Bone and Joint Surgery
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