Sloppy Hinge Prosthetic Replacement in Old Healed Side Swipe Injuries of Elbow - Long term Results

Sideswipe injuries of elbow often poses significant functional loss resulting from devastating injuries involving osseoligamentous structures as well as multilevel soft tissue injuries around the elbow. Inspite of treatment, no conscientious treatment opinion is available in the literature to provide optimum functional outcome. The objective of this study is to evaluate the results of prosthetic replacement of old healed sideswipe injuries of elbow with gross dysfunctional disabilities resulting from loss of bones and muscles around the joint.

Fourteen patients of 2-3 years old healed sideswipe injuries of the elbow, treated by Baksi sloppy hinge (original version in seven and recent version in seven) prosthetic replacement were evaluated. All had normal neurovascular status except two; one having ulnar nerve deficit the other median nerve in another. The mean age was 42.7 years (range 32-61 years).

The average followup period was 13.5 years (range 5.11-23.11 years). Ten patients regained stable 0° to 130° elbow flexion, and four had restricted terminal flexion with arc 10°-115° following V-Y plasty of contracted triceps. Mean supination was 22° and mean pronation was 35°. According to Mayo Elbow Performance Score (MEPS), excellent results were in five (35.7%), good in six (42.8%), and fair in one (7.1%). Two patients (14.2%) needed removal of prosthesis due to intractable delayed infection and considered failure. Following removal, the resected elbow retained relatively stable motions due to mature fibrous tissues connecting the adjacent bone ends and reorientation of muscle balance. Postoperative improvement of MEPS (mean 84) was significant (P = 0.0037) compared to preoperative value (mean 41.7). Two patients had superficial wound infection and five aseptic loosening of which one was symptomatic.

Prosthetic replacement of elbow is an effective salvage procedure in old healed sideswipe injuries.