Description
Elbow Fixator
Q&A
Q1: What is an elbow fixator and what are its primary clinical applications?
A1: An elbow fixator is an external stabilization device used to treat complex elbow fractures, dislocations, and instability. Its primary applications include terrible triad injuries, comminuted distal humerus or proximal ulna fractures, elbow instability with ligamentous damage, and cases where internal fixation alone cannot provide sufficient stability.
Q2: What is the difference between static and hinged elbow fixators?
A2: Static fixators completely immobilize the elbow joint, while hinged fixators incorporate an articulated joint that allows controlled range of motion. Hinged fixators are preferred when early motion is desirable to prevent stiffness, provided there is adequate bony and ligamentous stability.
Q3: How is the axis of rotation determined and replicated in a hinged fixator?
A3: The axis of rotation runs through the center of the capitellum and trochlea. During surgery, it is identified using fluoroscopy and precise anatomical landmarks. The hinge must be carefully aligned with this axis to allow physiological motion without creating damaging joint forces.
Q4: What are the most common complications and their management strategies?
A4: Common complications include:
Pin tract infections (most frequent): Managed with oral antibiotics and meticulous pin care
Ulnar nerve irritation: Often requires pin repositioning
Stiffness and heterotopic ossification: Addressed with early motion and sometimes prophylaxis
Joint contractures: Prevented through controlled rehabilitation
Q5: What is the typical duration of fixation and rehabilitation protocol?
A5: Most elbow fixators remain for 6-8 weeks. Rehabilitation begins immediately with:
Week 1-2: Gentle active-assisted range of motion
Week 3-6: Progressive strengthening and motion exercises
After removal: Intensive therapy to restore full function
Q6: What are the key indications for using an elbow fixator over internal fixation alone?
A6: Key indications include:
Severe comminuted fractures not amenable to stable internal fixation
Complex fracture-dislocations with ligamentous insufficiency
Open injuries with significant soft tissue compromise
Revision cases with failed previous fixation
Polytrauma patients requiring temporary stabilization
Q7: How is joint reduction and alignment verified and maintained during application?
A7: Verification involves:
Intraoperative fluoroscopy in multiple planes
Direct visualization through surgical approaches when possible
Ensuring concentric reduction on lateral fluoroscopic view
Confirming appropriate joint space throughout range of motion
Q8: What are the specific rehabilitation milestones of Elbow External Fixator and how are they monitored?
A8: Key milestones include:
Early phase (0-2 weeks): Achieve 30-90° motion without pain
Intermediate phase (2-6 weeks): Progress to 15-120° range
Advanced phase (6+ weeks): Work toward full functional range
Monitoring includes regular clinical exams and radiographic assessment of joint space and alignment.
