Restoring Stability and Motion: Controlled Early Uniplanar Mobilization using Dynamic External Fixation in Chronic Unstable Elbow Dislocations - A Case Series
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Published on: May 23, 2025
Karthik Velayudham1, Sree Suganya1, Premkumar Iyyanarappan1
1Department of Orthopedics, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.
Introduction:
Chronic unstable elbow dislocations are challenging due to soft tissue contractures, ligament insufficiency, and joint stiffness. Traditional immobilization often leads to poor functional recovery. Dynamic external fixation allows joint stability while enabling controlled early mobilization. This study evaluates functional outcomes of staged uniplanar mobilization using a dynamic external fixator in chronic unstable elbow dislocations.
Materials And Methods:
Six adult patients with chronic (>3 weeks) unstable elbow dislocations were prospectively treated between January 2023 and June 2025. Closed reduction was attempted but failed in all cases. Open reduction, excision of fibrous tissue and bony fragments, ligament repair, and AO external fixator application (two humeral and two ulnar pins) were performed. Staged mobilization was initiated at 2 weeks postoperatively (10°, 40°, 90°, 120° daily locks, as tolerated). Fixators were removed at 6 weeks. Functional outcomes were assessed using range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) preoperatively, at 3 weeks, 3 months, and 6 months.
Results:
Mean preoperative flexion-extension arc improved from 28° to 108° at 6 months. Mean MEPS improved from 44 to 87. Stable reduction was achieved in all patients. Two patients developed superficial pin tract infections, which resolved with oral antibiotics. No major complications were observed.
Conclusion:
In this six-patient case series, open reduction and ligament repair supplemented by dynamic external fixation and controlled staged mobilization maintained stable reduction and were associated with progressive improvement in ROM and MEPS at 6 months. The technique provided a practical means of protecting the reconstructed elbow while permitting rehabilitation. Larger comparative studies with longer follow-up are required before conclusions regarding superiority or long-term outcomes can be made.
