Review of management of unstable elbow fractures

Table 1 Reviewed studies investigating unstable elbow fracture diagnosis and treatment

Author	Ring et al[16]	Chemama et al[22]	Konrad et al[26]	Mouhsine et al[29]	Zeiders et al[21]	Winter et al[13]	Mortazavi et al[30]	Strauss et al[27]
Year	2002	2010	2007	2007	2008	2009	2006	2006
Mean age (range)	36 (17-62)	46 (26-75)	42.1 (21-72)	54 (22-82)	NA	40 (18-77)	35 (22-58)	UHD+: 46.8 UHD-: 55
n (female/male)	56 (21/35)	23 (7-16)	63 (22/41)	14 (8/6)	32 (NA)	13 (4/9)	8 (1/7)	UHD+: 6 (2/4) UHD-: 17 (12/5)
Radial fracture Mason classification	Type 2: 30 Type 3: 26	Type 1: 2 Type 2: 9 Type 3: 10 Radial neck: 2	Type 2: 7 Type 3: 9	NA	NA	13 non-reperable RH fracture	Type 1: 1 Type 3: 1	UHD+: Type 1: 1 Type 2: 2 Type 3 : 3
Coronoid fracture classification R-M	NA	Type 1: 16 Type 2: 7	NA	NA	NA	Type 1: 5 Type 2-3: 8	Type 3: 4	UHD+: Type 1: 4 Type 3: 2
Monteggia fracture classification (BADO)	NA	NA	Type 1: 19 Type 2: 37 Type 3: 5 Type 4: 2	NA	NA	NA	NA	Type 2: 6 (UHD+) Type 2: 17 (UHD-)
Time to surgery	NA	NA	First 24 h	NA	NA	1.9 d (1-4)	3.8 d	NA
Monteggia fracture Ulna treatment	NA	NA	Bado 1, 3, 4 (26 3.5 mm DCP) Bado 2 (26 plate, 11 tension band)	NA	NA	NA	NA	UHD+: Small fragment plates UHD-: Small fragment plates
Transolecranon fracture treatment	NA	NA	NA	K-wire and tension band: 7 3.5 mm 1/3 plate: 2 3.5 mm DCP: 1 3.5 mm recon. plate: 4	NA	NA	3.5 mm AO recons. Plate: 7 K-wire and tension band: 1	NA
Coronid treatment	NA	None: 10 TOS: 3 Anchor: 2 Screw: 4 Plate: 1 Resection: 3	Lag screws through the ulnar plate or indirect repositioning	NA	32 patients repair of coronoid brachialis Complex pull-through suture tec	NA	4 patients interfragmentary Screws through the plate	UHD+: Type 3 (lag screws)
Radial head treatment	Mason 2: 26 (screw), 4 (plate, screw) Mason 3: 22 (plate, screw), 4 (screw)	13 mini screws Radial neck: 2 plate RHP: 4 PRHR: 2 TRHR: 2	46 luxation CR 12 RH ORIF 4 RH resection	NA	6-intact RH 7-reconst 19-prothesis	13 RHP	1 type 1: Mini screws 1 type 3: Total exicision RH	Type 1, 2: mini fragment plates Type 3: 3 replacement
LCL repair	NA	NA	NA	None	18 (anchor) 12 (mcl + lcl rep)	No: 4 abs suture Used for repair	NA	UHD+: 6
MCL repair	NA	NA	NA	None	2 (ancor) 12 (mcl + lcl rep)	NA	NA	UHD+: 0
External fixator	NA	None	NA	None	21 hinged ex-fix	NA	NA	UHD+: 1 hinged ex-fix
Follow-up	48 mo	63 mo	8.4 yr (5-14) (47 patients)	42 mo (7-84)	3 yr (1-5)	25 mo (15-48)	37.4 mo (10-50)	UHD+: 28 mo (14-48) UHD-: 29 (12-60)
Range of motion	MFA Mason 2: 119 Mason 3: 111	MFA: 109 MSA: 64 MPA: 70	MFA: 97.5 MFR: 125	MFA: 103 MSA: 76 MPA: 68	MFA: 100	MFA: 120	MFA: 93 MFR: 157.5	UHD+: MFA 95, MSA 55, MPA 50 UND-: MFA 122, MSA 67, MPA 60
Mean score	Mason 2: BM: 92 Mason 3: BM: 86	MEPS: 87 (75-100) 14 patients result	BM: 87.2 (45-100) DASH: 17.4 (0-70)	BM: 82 (78-100)	DASH: 23 (19/28)	BM: 86.5 (55-100)	BM: 88 (71-100) ASES: 89 (69-100)	UHD+: DASH 34 (0-80), BM: 73.8 UHD-: DASH 23 (0-70), BM: 83
Unsatisfactory	Mason 2: 4 Mason 3: 14	BM: 0	BM: (9 fair) (4 poor) result	BM: 2 fair 2 poor		2 (stiffness, infection)	BM: 1 fair	UHD+: 2 UHD-: 7

NA: Not applicable; UHD: Ulnohumeral dislocation; RH: Radial head; R-M: Roger Morrey; DCP: Dynamic compression plate; TOS: Transosseous suture; RHP: Radial head prosthesis; PRHR: Partial radial head resection; TRHR: Total radial head resection; MFA: Mean flexion arch; MSA: Mean supination arch; MPA: Mean pronation arch; MFR: Mean forearm rotation; BM: Broberg and Morrey index; MEPS: Mayo elbow performance score; DASH: Disabilities of the arm shoulder and hand; ASES: American Shoulder and Elbow Surgeons assessment system; LCL: Lateral collateral ligament; MCL: Medial collateral ligament.