Outcome of longstanding dislocated elbows treated by open reduction and excision of collateral ligaments

To study the long term result of open reduction of longstanding dislocated elbows with regard to stability, avascular necrosis of the distal humerus and degenerative changes of the joint. Nine patients, aged between nine and 60 years (average 30 years) with longstanding posterior dislocation of the elbow underwent open reduction. The operative procedure featured a medial and lateral incision, excision of the capsule, fibrous adhesions and the collateral ligaments with no attempt to reconstruct the ligaments, as well as anterior transposition of the ulnar nerve. The procedure was performed on an average eight months after the injury (range 1.5 to 30 months). All elbows had improved flexion at follow-up which ranged from one to eleven-and-half years (average 48 months). The average arc of flexion improved from 11 degrees to 87 degrees. The average flexion at the elbow improved from 32 degrees (range 20 degrees - 50 degrees ) to 111 degrees (range 85 degrees - 140 degrees ). Younger patients with fractures of the articular surface of distal humerus had smaller gain in the range of motion. No patient complained of instability or had recurrence of dislocation. No patient developed avascular necrosis of the distal end of the humerus. The radiographs of the 60-year-old man at 11.5 years follow-up showed extensive degenerative changes of the joint but he still maintained a painless arc of flexion from 10 degrees to 135 degrees. There was improvement in the range of motion and function in all nine patients. The elbows were stable despite excision of the collateral ligaments. There was no evidence of avascular necrosis. Patients with eight or more years of follow-up showed degenerative changes of the joint.