2025 ISAKOS Biennial Congress Paper
Preliminary Results of Internal Joint Stabilizer Covered by an Anconeus Flap for Elbow Instability
Angelo De Crescenzo , MD, Bari ITALY
Raffaele Garofalo, MD, Acquaviva Delle Fonti-Ba ITALY
Andrea Celli, MD, Modena, Modena ITALY
Hesperia Hospital, Modena, Modena, ITALY
FDA Status Not Applicable
Summary
The present study supports the safety and efficacy of the internal device in a submuscular layer, that is covered by the anconeus muscle.
Abstract
The management of residual elbow instability is a challenge in both acute and chronic injuries. Hinged external fixators have been used but they are clumsy and associated to high rate of pin track complications. To address these issues, an internal joint stabilizer (IJS) was developed, but a subcutaneous frame may provide local tenderness and patients ‘complains. To improve the local comfort, an alternative surgical approach in which the internal device is covered by the anconeus muscle becoming submuscular rather than subcutaneous is described. The present study evaluates the feasibility and the benefit of an IJS covered by an anconeus flap. Short term results, patients’ satisfaction, adverse events, and consequences on device removal were compared with a traditional technique with the device implanted above the anconeus.
As a preliminary analysis of a multicenter study started in January 2022, a retrospective study was performed focusing on influence that an anconeus flap position in relation to the IJS can have on short term results, local adverse events, patients ‘satisfaction and device removal. The patients selected were divided in two groups: (group A) “IJS under anconeus”; (group B) “IJS above anconeus”.
The selection criteria resulted in a group of 10 patients for group A and 15 patients for group B. At an average follow-up of 3.5 months (range, 2-11 months), there was no significant difference between two groups in terms of all parameters analyzed. However, a trend for better tolerability and satisfaction in patients with the IJS covered by the anconeus flap can be noticed. Despite a slightly longer removal procedure, no additional significant damage on muscle belly has been observed at the time of implant removal, which is pulled out from the base plate.
The IJS represents an effective and reliable option as a temporary stabilization for residual elbow instability. When performing a lateral approach with an anconeus flap, the internal device can be covered by the muscle belly at the end of the procedure. The preliminary results suggest at least similar tolerance and patient ‘satisfaction without any relevant increase in complication rate at time of removal surgery.