Treatment of the chronically subluxated elbow (persistent elbow instability)

Inadequate treatment of unstable elbow injuries, such as terrible triad elbow fracture-dislocations, can result in persistent elbow instability. While the treatment options continue to evolve, there are strategies to avoid this complication or to restore stability when faced with this difficult scenario. Treating the acute injury adequately requires stable radial head fixation or arthroplasty, stable coronoid fixation and lateral collateral ligament repair. External fixation, either hinged or fixed, may be required in cases with persistent instability. In cases where coronoid fracture repair is not possible, reconstruction can be performed with radial head autograft, olecranon autograft, iliac crest autograft, or other allograft alternatives. Recently there is an option of coronoid prosthesis to improve stability with promising results in cadaveric studies. The aim of this chapter is to try to unify the different treatment options in the management of the chronically subluxed or unstable elbow after a fracture-dislocation.