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Is Magnetic Resonance Imaging Useful In Predicting Instability In Patients Who Sustain A Simple Elbow Dislocation?
EP33131
Poster Title: Is Magnetic Resonance Imaging Useful In Predicting Instability In Patients Who Sustain A Simple Elbow Dislocation?
Submitted on 13 Oct 2020
Author(s): Francis AO, Kelly MJ, Foran P, McCarthy E, Flannery OM
Affiliations: Connolly Hospital, Dublin, Ireland
Poster Views: 73
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Poster Information
Abstract: The Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) of the elbow function to provide stability against valgus and varus stresses respectively. These strong ligament complexes are often injured in simple elbow dislocations with the potential for resulting instability. There are competing theories regarding which ligament complex is more commonly injured. It is broadly thought that injury to the MCL is more commonly due to repetitive stresses where as the LCL is more commonly injured in acute events.

Aims

To determine whether The Lateral Collateral Ligament is affected more commonly than the Medial Collateral Ligament in unstable simple elbow dislocations.

Methods

A retrospective review of twenty-four consecutive simple elbow dislocations that required surgical stabilisation was performed. A review of the operative note was undertaken to identify the injured ligament and the anatomical site of injury.

Results

There were 24 unstable simple elbow dislocations that underwent surgical stabilisation following acute injury. There were 9 MCL repairs, 4 LUCL repairs and 11 combined MCL and LCL repairs. The MCL was injured at the medial epicondyle of the humerus in 17 cases, with one intra substance tear and two injuries at its insertion to the sublime tubercle. The LUCL was injured at the lateral epicondyle in 14 cases with one injury occurring at its insertion.

Conclusion

In this cohort, the MCL is more commonly affected than the LCL, however injury to both ligament complexes was seen most commonly. In the majority of cases, injury occurs at the ligament’s origin however insertion site injuries must also be taken into account prior to surgical stabilisation.
Summary: Magnetic Resonance Imaging is not a good predictor of instability post elbow
dislocation.

High sensitivity and low specificity indicates that unstable ligament injuries tend to be over diagnosed.

Clinical examination remains key and where instability suspected – we recommend examination under anaesthesia followed by stabilisation if required.
References: 1.Stoneback JW, Owens BD, Sykes J, Athwal GS, Pointer L, Wolf JM (2012)
Incidence of elbow dislocations in the United States population. J Bone Joint Surg
Am 94(3):240–245
1. Hildebrand KA, Patterson SD, King GJ (1999) Acute elbow dislocations: simple
and complex. Orthop Clin North Am 30(1):63–79
2. Anakwe RE, Middleton SD, Jenkins PJ, McQueen MM, Court- Brown CM (2011)
Patient-reported outcomes after simple dislo- cation of the elbow. J Bone Joint
Surg Am 93(13):1220–1226
3. Dehlinger FI, Ries C, Hollinger B (2014) LUCL reconstruction using a triceps
tendon graft to treat posterolateral rotatory insta-
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