Treatment of complex elbow injuries with a postoperative custom-made progressive stretching static elbow splint

Complex elbow injuries consist of fractures of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, collateral ligaments, and capsular complex. These injuries, if not properly treated, were reported to have a poor prognosis with recurrent instability, stiffness, posttraumatic arthrosis, and pain. This study was conducted to review clinical outcomes after fracture stabilization and ligament repair with a postoperative custom-made progressive stretching (CMPS) elbow splint in the treatment of complex elbow injuries.

From December 2001 to October 2006, 14 patients with complex elbow fractures or instability underwent surgery in Far Eastern Memorial Hospital by Chang Chih-Hung, using suture anchors. All patients used our CMPS static elbow splint postoperatively. No hinged elbow external skeletal fixator was necessary. The results were reviewed retrospectively.

The patients were followed up for an average of 14 months. The mean (standard deviation) flexion-extension range of motion (ROM) was 116-degree angle (23-degree angle). The mean Mayo Elbow Performance Score was 92 points; the results were excellent in 10 patients, good in three patients, and fair in one patient.

The dilemma in managing complex elbow injuries is that extended immobilization leads to stiffness, but without proper reconstruction of the stabilizer, joint instability recurs. Our surgical protocol included removal of all loose bodies within the joint, stable fixation of fracture fragments if possible, and use of suture anchors to repair medial or lateral ulnar collateral ligaments. CMPS static elbow splints provided both postoperative protection and ROM movement. In our experience, if the stabilizers were reconstructed, hinged elbow external skeletal fixator is usually not necessary, and progressive stretching by CMPS splint can result in good ROM.