TITLE:
Treatment of Neglected Elbow Dislocations by Z-Lengthening of the Triceps Brachii
AUTHORS:
M’Bra Kouamé Innocent, Kouassi Kouamé Jean-Eric, Yao Loukou Blaise, AkobéJean Regis Achie, Sery Bada Justin Léopold, KouassiAya Adélaïde Natacha, Krah Koffi Leopold, Michel Kodo
KEYWORDS:
Elbow, Dislocation, Neglected, Triceps Plasty, Posterior Approach
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.12 No.4,
April
18,
2022
ABSTRACT: Introduction: Neglected elbow dislocations are much more common in developing and
underdeveloped countries. The main reason for the delay in diagnosis is that
patients initially seek treatment from traditional healers. These will
immobilize the elbow in extension, which will lead to the retraction of the triceps
muscle and collateral ligaments. Patients and Method: We carried out a
prospective study over five years (2014-2019). The study involved patients with
unreduced elbow dislocation older than 21 days. All patients with a dislocated
fracture and those whose x-ray showed joint fusion were not included in the
study. We collected 26 patients, 20 men and 6 women with an average age of 27.5
years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The
approach was posterior about 8 cm above the olecranon and 2 cm below the
olecranon, the ulnar nerve was identified and isolated. The triceps tendon was
cut in a Z from its myotendin junction to the beak of the olecranon, and then
lengthened. Results: The patients were reviewed after a mean follow-up
of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with
19 good and 6 average results. The mean flexion was 114° (100° - 135°) and the mean extension deficit was 31.15° (10° - 55°). The average range of motion was 82.5° (60° - 120°). We did not find a correlation between the duration of the lesion and
functional recovery (p >
0.05). The Wilcoxon test showed that surgery significantly improved the overall
range of motion of the elbow (p = 0.001). Discussion: Based on this
study, open reduction with tendon lengthening should remain a treatment option
regardless of the age and chronicity of the dislocation.