Bridge Plating is an Effective Adjunct Treatment for Complex Elbow Instability

Adeeba A Albadran; Saad M AlQahtani; Ruby Grewal; Kenneth J Faber; George S Athwal; Graham J W King

doi:10.1016/j.jse.2024.03.013

Bridge Plating is an Effective Adjunct Treatment for Complex Elbow Instability

J Shoulder Elbow Surg. 2024 Apr 18:S1058-2746(24)00262-3. doi: 10.1016/j.jse.2024.03.013. Online ahead of print.

Authors

Adeeba A Albadran¹, Saad M AlQahtani², Ruby Grewal³, Kenneth J Faber³, George S Athwal³, Graham J W King⁴

Affiliations

¹ Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
² Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
³ Department of Surgery, St. Joseph's Health Care, Hand and Upper Limb Centre, Western University, London, ON, Canada.
⁴ Department of Surgery, St. Joseph's Health Care, Hand and Upper Limb Centre, Western University, London, ON, Canada. Electronic address: gking@uwo.ca.

PMID: 38642878
DOI: 10.1016/j.jse.2024.03.013

Abstract

Background: Managing persistent elbow instability and chronic dislocations presents challenges despite traditional treatments. Supplementary methods like immobilization and various fixations, though common, can carry high complication rates. This study assesses the efficacy of bridge plating in treating complex elbow instability through a retrospective review of patients. Data on characteristics, treatment duration, range of motion, complications, and evaluation scores were analyzed, providing insights into outcomes complications associated with bridge plating.

Results: Eleven patients were reviewed at an average follow-up of 80 ± 68 weeks. postoperatively. The average age was 53±14 years and there were 5 females and 6 males. The average BMI was 38. Bridge plating was used for a spectrum of complex elbow injuries. The average time from injury to bridge plating in acute cases was 29±19 days and 344±381 days in chronic cases. The average duration of bridge plating was 121 ± 72 days. At the time of plate removal, mean intraoperative elbow motion was extension 58±12°, flexion 107±14°, supination 66±23° and pronation 60±26°. At the latest follow-up visit, average elbow motion was extension 37±22°, Flexion 127± 17°, supination 72±15° and pronation 63±18°. There were 6 complications (55%); heterotopic ossification, ulnar neuropathy, wound failure over the plate in a thin patient, an ulnar shaft peri-prosthetic fracture due to a seizure induced fall, and elbow subluxation despite bridge plate fixation. One patient sustained a fracture of a 3.5mm locking bridge plate. One patient required a contracture release for persistent stiffness. Four of these complications can be directly attributed to the use of the bridge plate (36%). At final follow-up, the average patient rated elbow evaluation score was 34, with 0 indicating no pain and disability. The average single assessment numeric evaluation score was 66% for the 8 patients who had this available, with 100% being the best possible attainable score.

Conclusion: Bridge plating effectively maintains joint reduction in selected complex elbow instability cases. However, patients with bridge plates often require a second surgery for removal and experience high rates of general complications due to the complexity of their condition.

Keywords: Bridge plate; Complex elbow trauma; Elbow; Outcomes; Persistent elbow instability; Surgical techniques.