Results of Open Reduction and V-Y Triceps Plasty of Old Unreduced Elbow Dislocations in 38 Patients with Severe Extension Deformity

Abstract

Introduction:  Old unreduced posterior elbow dislocation is fairly common in developing countries due to delay in presentation after initial intervention by the traditional bone setters. This poses a huge management challenge for orthopaedic surgeons because of the accompanying triceps retraction. In this article, we report outcome of treatment of old unreduced elbow dislocations with severe extension deformities using open reduction with V-Y tricepsplasty through the posterior approach.  Methodology: This was a retrospective study of/involving 38 patients operated with pld unreduced posterior elbow dislocations from August 2015 to March 2023. The presentation was within 3 to 18 months from the injury time at the orthopaedic hospital Wamakko, Sokoto, Nigeria. There were 31 males, and 7 females with mean age of 32 (range 18 to 64years). The mean elbow flexion was 11° (range was 5° to 45°) before the procedure. Our management protocol was the use of posterior elbow joint approach and Speed Technique of V-Y plasty for triceps lengthening and stabilizing the reduced joint with kirschner (K) wire.  Results: The mean patients’ follow up was 21 (range 16 to 26 months). The average Mayo elbow performance index (MEPI) score on admission was 54, while the average MEPI score after the procedure was 88,with 29 (76 %) patients having excellent result, 3 (8%) with good result, 5 (13%) with fair, and 1 (3)% with poor results. On the scale of pain, the mean score was 42; the mean elbow flexion was 11° (range 5° to 45°) before the procedure, and after surgery the mean score was 118° (range 45° to 135°). Complications were 5 cases of ulnar nerve neuropraxia that all resolved within first 3 months postoperatively. Two cases of heterotopic ossifications and 1 postoperative elbow stiffness all significantly improved following rehabilitation therapy. Conclusion: The functional outcome of old unreduced elbow dislocations presenting with severe extension deformity can be satisfactory following open reduction and V-Y Tricepsplasty.