Comparing internal and external stabilization for traumatic elbow instability: a systematic review

John J Heifner; Ty A Davis; Robert J Rowland; Osmanny Gomez; Robert R L Gray

doi:10.1016/j.xrrt.2023.12.004

Comparing internal and external stabilization for traumatic elbow instability: a systematic review

JSES Rev Rep Tech. 2024 Jan 18;4(2):196-203. doi: 10.1016/j.xrrt.2023.12.004. eCollection 2024 May.

Authors

John J Heifner¹, Ty A Davis², Robert J Rowland², Osmanny Gomez², Robert R L Gray³

Affiliations

¹ Miami Orthopaedic Research Foundation, Miami, FL, USA.
² Larkin Hospital Department of Orthopaedics, Coral Gables, FL, USA.
³ NorthShore Department of Orthopedics, Chicago, IL, USA.

Abstract

Background: Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS.

Methods: A database query was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Population, Intervention, Comparison and Outcome characteristics for eligibility were the following: for patients over 18 years clinical outcomes were compared between an ExFix or the IJS for acute or chronic elbow instability. The Cochran risk of bias in nonrandomized studies of interventions and grades of recommendation, assessment, development, and evaluation framework were compiled for risk of bias and quality assessment.

Results: The rate of recurrent instability was 4.1% in the IJS group (N = 171) and 7.0% in the ExFix group (N = 435), with an odds ratio of 1.93 (95% confidence interval 0.88-4.23). The rate of device failure was 4.4% in the IJS group and 4.1% in the ExFix group. Pin-related complications occurred in 14.6% of ExFix cases. Complications in the IJS group were the following: 1 case of inflammatory reaction, 4 cases of post removal surgical site infection, and 5 symptomatic removals.

Discussion: The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. Although not statistically significant, the higher rate of recurrent instability following external fixation may be clinically important. The high rate of pin-related complications with external fixation is notable.

Keywords: Elbow instability; External fixation; Hinged external fixator; Internal joint stabilizer; Persistent instability; Pin-tract infection.