Elbow subluxation and dislocation: A spectrum of instability

S. W. O'Driscoll, B. F. Morrey, S. Korinek, K. N. An

Research output: Contribution to journalArticle

363 Citations (Scopus)

Abstract

After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medial collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34°-50° and 5°-23° valgus at about 80° flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3°-2.4°) in valgus laxity after reduction compared with the intact specimens (p > 0.05, β = 0.1, Δ = 2.5°). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p < 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body 'rotating internally' on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.

Original languageEnglish (US)
Pages (from-to)186-197
Number of pages12
JournalClinical Orthopaedics and Related Research
Issue number280
StatePublished - 1992
Externally publishedYes

Fingerprint

Elbow
Collateral Ligaments
Pronation
Supination
Braces
Electromagnetic Phenomena
Ligaments
Biomechanical Phenomena
Capsules
Autopsy
Rehabilitation
Hand
Equipment and Supplies

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

O'Driscoll, S. W., Morrey, B. F., Korinek, S., & An, K. N. (1992). Elbow subluxation and dislocation: A spectrum of instability. Clinical Orthopaedics and Related Research, (280), 186-197.

Elbow subluxation and dislocation : A spectrum of instability. / O'Driscoll, S. W.; Morrey, B. F.; Korinek, S.; An, K. N.

In: Clinical Orthopaedics and Related Research, No. 280, 1992, p. 186-197.

Research output: Contribution to journalArticle

O'Driscoll, SW, Morrey, BF, Korinek, S & An, KN 1992, 'Elbow subluxation and dislocation: A spectrum of instability', Clinical Orthopaedics and Related Research, no. 280, pp. 186-197.
O'Driscoll, S. W. ; Morrey, B. F. ; Korinek, S. ; An, K. N. / Elbow subluxation and dislocation : A spectrum of instability. In: Clinical Orthopaedics and Related Research. 1992 ; No. 280. pp. 186-197.
@article{19a9c89be32446f89dbe92b70e8255b5,
title = "Elbow subluxation and dislocation: A spectrum of instability",
abstract = "After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medial collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34°-50° and 5°-23° valgus at about 80° flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3°-2.4°) in valgus laxity after reduction compared with the intact specimens (p > 0.05, β = 0.1, Δ = 2.5°). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p < 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body 'rotating internally' on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.",
author = "O'Driscoll, {S. W.} and Morrey, {B. F.} and S. Korinek and An, {K. N.}",
year = "1992",
language = "English (US)",
pages = "186--197",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "280",

}

TY - JOUR

T1 - Elbow subluxation and dislocation

T2 - A spectrum of instability

AU - O'Driscoll, S. W.

AU - Morrey, B. F.

AU - Korinek, S.

AU - An, K. N.

PY - 1992

Y1 - 1992

N2 - After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medial collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34°-50° and 5°-23° valgus at about 80° flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3°-2.4°) in valgus laxity after reduction compared with the intact specimens (p > 0.05, β = 0.1, Δ = 2.5°). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p < 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body 'rotating internally' on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.

AB - After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medial collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34°-50° and 5°-23° valgus at about 80° flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3°-2.4°) in valgus laxity after reduction compared with the intact specimens (p > 0.05, β = 0.1, Δ = 2.5°). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p < 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body 'rotating internally' on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.

UR - http://www.scopus.com/inward/record.url?scp=0026783937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026783937&partnerID=8YFLogxK

M3 - Article

C2 - 1611741

AN - SCOPUS:0026783937

SP - 186

EP - 197

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 280

ER -