Instabilidade do Cotovelo Folheto

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Complex elbow instability requires balancing stability, mobility, and concentric reduction [1].
• Further research, particularly multicenter prospective trials, is needed for complex elbow instability due to the rare nature of these injuries [1].
• Elbow instability in children involves nontraumatic causes as well as traumatic injuries [2].
• Elbow arthroscopy is a valid and safe option for diagnosing and treating acute elbow instability [3].
• Elbow arthroscopy is a valid and safe option for diagnosing and treating chronic elbow instability [3].
• Elbow arthroscopy allows management of soft tissue lesions in elbow instability with minimal disruption [3].
• Elbow arthroscopy allows management of associated intra-articular bone or cartilage lesions in elbow instability with minimal disruption [3].
• Elbow arthroscopy is a valuable tool for diagnosing chronic elbow instability [6].
• Elbow arthroscopy is a valuable tool for managing chronic elbow instability [6].
• Elbow instability injuries are an infrequent source of disability for select NCAA athletes [4].
• Elbow instability injuries are a serious source of disability for select NCAA athletes [4].
• There are associated risk factors for elbow instability injuries in NCAA athletes [4].
• Good long-term outcomes are reported after non-operative management of simple elbow dislocations [8].
• Approximately 2% of patients require surgical intervention if simple elbow dislocations are treated nonoperatively [8].
• Approximately 8% of patients develop persistent instability symptoms if simple elbow dislocations are treated nonoperatively [8].
• A standard surgical protocol for treating elbow dislocations with radial head and coronoid fractures restores sufficient stability to allow early motion postoperatively [17].
• Early motion postoperatively enhances functional outcome in elbow dislocations with radial head and coronoid fractures treated with a standard surgical protocol [17].
• Operative repair is indicated for most fracture-dislocations of the elbow to restore sufficient osseoligamentous support [20].
• Restoring sufficient osseoligamentous support allows safe, early motion in elbow fracture-dislocations [20].
• Restoring sufficient osseoligamentous support provides a stable functional elbow in the long term for elbow fracture-dislocations [20].
• Current evidence regarding the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction possesses a high degree of fragility [25].
• Further studies with objective measurements are needed to determine the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction [25].
• Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced [27].
• Surgery is indicated for unstable periarticular fractures [27].
• Instability is the major complication of unlinked total elbow arthroplasty [30].
• Instability after unlinked total elbow arthroplasty often requires revision [30].
• Linked arthroplasty is preferred for patients with posttraumatic articular damage [30].
• Linked arthroplasty is preferred for patients with ligamentous instability [30].
• Linked arthroplasty is preferred for patients with deformity [30].
• Linked arthroplasty is preferred for patients with bone loss [30].

Anatomy & Pathophysiology

• The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability [18].
• Simple dislocations of the elbow are highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers [28].
• Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed [21].
• Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness [9].
• An understanding of the relevant anatomy and the factors associated with elbow stability allows for the application of a systematic algorithm for treatment [12].
• Optimal outcomes are founded upon concentric reduction of the elbow [19].
• The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion [15].
• A stiff, congruent elbow is preferable to an unstable elbow [36].
• PLRI of the elbow remains to be fully understood [34].

Classification

• Complex elbow instability is a distinct clinical entity requiring a balance between stability, mobility, and concentric reduction [1].
• Complex elbow instability is rare, necessitating multicenter prospective trials for further research [1].
• Elbow instability in children includes nontraumatic causes in addition to traumatic injuries [2].
• The Wrightington classification of traumatic elbow instability is a comprehensive, reliable, and valid classification system [32].
• The Wrightington classification is associated with treatment algorithms that lead to good functional outcomes [32].
• Understanding the precise pattern of injury is critical for restoring elbow function and preventing chronic instability, pain, and weakness [9].
• Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes [4].
• Elbow instability injuries in NCAA athletes have associated risk factors [4].
• The elbow consists of static and dynamic stabilizers that function in synchrony to prevent instability [18].
• Understanding elbow biomechanics and injury mechanisms provides insight into variations of pathology in traumatic elbow instability [21].
• Understanding patterns of traumatic elbow instability helps surgeons counsel and manage patients [7].
• An algorithmic approach to diagnosis and treatment of complex elbow fracture-dislocations can improve diagnostic assessment and reconstruction of bony and ligamentous restraints [29].
• A systematic algorithm for treatment of terrible triad injuries, based on anatomy and stability factors, ensures sufficient stability for early motion and improved outcomes [12].
• A treatment algorithm for elbow dislocations, ranging from soft tissue injuries to complex fracture-dislocations, is based on clinical evidence and addresses basic scientific aspects of treating elbow stiffness [22].

Clinical Presentation

• Complex elbow instability is a challenging clinical entity requiring a balance between stability, mobility, and concentric reduction [1].
• Elbow instability in children includes nontraumatic causes [2].
• Elbow arthroscopy is a valid and safe option for the diagnosis of acute elbow instability [3].
• Elbow arthroscopy is a valid and safe option for the diagnosis of chronic elbow instability [3].
• Elbow arthroscopy is a valid and safe option for the treatment of acute elbow instability [3].
• Elbow arthroscopy is a valid and safe option for the treatment of chronic elbow instability [3].
• A simple elbow dislocation that is rotationally unstable can be stabilized by simply repositioning the forearm [5].
• Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries [7].
• Good long-term outcomes have been reported after non-operative management of simple elbow dislocations [8].
• A small proportion (2%) of patients require surgical intervention if simple elbow dislocations are treated nonoperatively [8].
• All patients in the series of lateral collateral ligament instability had resolution of their symptoms of instability [10].
• Patients with lateral collateral ligament instability regained a near full arc of elbow flexion and forearm rotation [10].
• Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability [11].
• An understanding of the relevant anatomy and factors associated with elbow stability allows the application of a systematic algorithm for treatment of terrible triad injuries [12].
• The systematic algorithm for terrible triad injury treatment helps ensure sufficient elbow stability to allow early motion [12].
• Early motion in terrible triad injury leads to improved outcomes in most patients [12].
• The next challenge for elbow surgeons is to diagnose and fix persistent subclinical instability after surgery to prevent the onset of post-traumatic osteoarthritis [13].
• Simple elbow dislocations are usually managed by closed reduction and early motion [16].
• Recurrent instability is uncommon in simple elbow dislocations due to intrinsic bony stability [16].
• Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament [23].
• Posterolateral rotatory instability of the elbow presents with clicking, locking, or recurrent dislocation [23].
• Most simple elbow dislocations are readily managed nonoperatively [24].
• Most simple elbow dislocations are amenable to early mobilization [24].
• The variability in patients' pathoanatomic conditions in chronic complex persistent elbow instability requires customized surgical treatment [31].
• Surgical treatment for chronic complex persistent elbow instability is aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved [31].
• Surgical treatment for chronic complex persistent elbow instability is aimed at joint replacement in case of severe articular degeneration [31].

Investigations

• Complex elbow instability requires recognition of the precise injury pattern to restore function and prevent chronic instability, pain, and weakness [9].
• Elbow instability injuries are an infrequent but serious source of disability for select National Collegiate Athletic Association (NCAA) athletes [4].
• Proximal radioulnar translocation with radial neck fracture and elbow dislocation is an extremely rare injury in children that requires careful radiographic evaluation to avoid delayed diagnosis [46].
• Concomitant vascular lesions, such as brachial artery transection, must be considered when confronted with elbow dislocations [44].
• Elbow arthroscopy is a valid and safe option for the diagnosis of both acute and chronic elbow instability [3].
• Elbow arthroscopy is a valuable tool in the diagnosis of chronic elbow instability [6].
• Nontraumatic causes of elbow instability in children are addressed in current concepts of pediatric elbow injuries [2].

Treatment

Non-Operative Management

• Most simple elbow dislocations are readily managed nonoperatively and are amenable to early mobilization [24].
• Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation [43].
• Simple elbow dislocations should be managed with early range of motion, as most do not require surgery [42].
• Rehabilitation programs for simple elbow dislocations should stress early active range of motion through the stable arc of motion [5].

Operative Management

• Operative repair is indicated for most fracture-dislocations of the elbow to restore sufficient osseoligamentous support to allow safe, early motion and provide a stable functional elbow in the long term [20].
• Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced or for unstable periarticular fractures [27].
• Elbow valgus instability in the throwing athlete may be managed either nonsurgically or surgically [39].
• Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome [17].
• Both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability [26].

Arthroscopic Management

• Elbow arthroscopy has become a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability, allowing for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption [3].
• Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability [6].
• Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve [35].

Surgical Goals and Outcomes

• The primary goal of treatment for nonacute elbow fracture with persistent ulnohumeral dislocation or subluxation is stable reduction of the ulnohumeral joint and functional elbow motion [15].
• Optimal outcomes for traumatic elbow instability are founded upon concentric reduction of the elbow [19].
• Complex elbow instability requires a balance between stability, mobility, and concentric reduction [1].
• Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [33].
• Few patients with simple elbow dislocations develop complications requiring surgery [14].
• Patients with simple elbow dislocations who require surgery most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury [14].
• A small proportion (2%) of patients require surgical intervention for simple elbow dislocations [8].

Complications

• Approximately 8% of patients treated nonoperatively for simple elbow dislocation develop persistent instability symptoms [8].
• A small proportion (2%) of patients with simple elbow dislocation require surgical intervention [8].
• Persistent subclinical instability after surgery can lead to the onset of post-traumatic osteoarthritis [13].
• Patients with simple elbow dislocations who develop complications most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury [14].
• Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [30].
• Linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [30].
• Ulnar collateral ligament reconstruction (UCLR) demonstrates low complication and revision rates at minimum 48-month mean follow-up [38].
• There is a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability [40].

Recovery

• Rehabilitation programs for rotationally unstable simple elbow dislocations should stress early active range of motion through the stable arc of motion [5].
• Non-operative management of simple elbow dislocations yields good long-term outcomes [8].
• Approximately 2% of patients treated nonoperatively for simple elbow dislocation require surgical intervention [8].
• Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness [9].
• Diagnosing and fixing persistent subclinical instability after surgery is necessary to prevent the onset of post-traumatic osteoarthritis [13].
• Patients with simple elbow dislocations who require subsequent surgery most commonly undergo soft-tissue stabilization or contracture release within 4 years of the injury [14].
• Recurrent instability is uncommon after simple elbow dislocation due to intrinsic bony stability [16].
• Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restores sufficient elbow stability to allow early motion postoperatively [17].
• Early motion postoperatively enhances functional outcome in the treatment of elbow dislocations with radial head and coronoid fractures [17].
• Athletes with elbow dislocation demonstrate excellent functional outcomes and high return to sport rates [41].
• Most athletes with elbow dislocation return to sport within 10 weeks [41].
• The prognosis for simple elbow dislocations is better than for complex dislocations [47].
• Prolonged immobilization is associated with unsatisfactory results in elbow dislocations [47].

Key Evidence

• [L5] Complex elbow instability remains a challenging clinical entity requiring a balance between stability, mobility, and concentric reduction; further research, particularly multicenter prospective trials, is needed due to the rare nature of these injuries. [1] (10.1016/j.hcl.2007.11.010)
• [L5] The article reviews current concepts of injuries leading to elbow instability in children, discusses recognition and treatment of instability, and addresses nontraumatic causes. [2] (10.1016/j.hcl.2007.11.007)
• [L5] Elbow arthroscopy has become a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability, allowing for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption. [3] (10.1016/j.jseint.2022.12.001)
• [L4] Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes, with a number of associated risk factors. [4] (10.1177/2325967117750105)
• [L5] A simple elbow dislocation that is rotationally unstable can be stabilized by simply repositioning the forearm, and rehabilitation programs should stress early active range of motion through the stable arc of motion. [5] (10.1016/j.hcl.2015.06.002)
• [L4] Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. [6] (10.1016/j.arthro.2013.08.016)
• [L5] Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries. [7] (10.1016/j.jhsa.2010.05.002)
• [L5] Good long-term outcomes have been reported after non-operative management of simple elbow dislocations; however, a small proportion (2%) of patients require surgical intervention and approximately 8% develop persistent instability symptoms if treated nonoperatively. [8] (10.1177/1758573217694163)
• [Paper] Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. [9] (10.1016/j.injury.2013.09.032)
• [L4] All patients in the series had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation. [10] (10.1016/j.hcl.2007.11.001)
• [L5] Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability. [11] (10.5435/00124635-200605000-00003)
• [L5] Despite the complexities of this injury, an understanding of the relevant anatomy and the factors associated with elbow stability allows the application of a systematic algorithm for treatment that can help ensure sufficient elbow stability to allow early motion, thereby leading to improved outcomes in most patients. [12] (10.5435/00124635-200903000-00003)
• [L5] The next challenge for elbow surgeons is to diagnose and fix persistent subclinical instability after surgery to prevent the onset of post-traumatic osteoarthritis. [13] (10.1016/j.jseint.2023.03.018)
• [Paper] Few patients with simple elbow dislocations develop complications requiring surgery, but those that do most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury. [14] (10.1016/j.injury.2015.02.009)
• [L5] The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion. [15] (10.2106/jbjs.m.00817)
• [L5] Simple elbow dislocations are usually managed by closed reduction and early motion, with recurrent instability being uncommon due to intrinsic bony stability. [16] (10.1016/j.hcl.2007.11.012)
• [L4] Use of the surgical protocol restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. [17] (10.2106/jbjs.d.02933)
• [L5] The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability. [18] (10.1016/j.jhsa.2016.11.025)
• [L5] Optimal outcomes are founded upon concentric reduction of the elbow. [19] (10.1016/j.jseint.2023.03.020)
• [L5] Operative repair is indicated for most of these injuries to restore sufficient osseoligamentous support to allow safe, early motion and provide a stable functional elbow in the long term. [20] (10.1016/j.hcl.2004.06.005)
• [L4] Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed. [21] (10.5435/jaaos-d-14-00023)
• [L5] The authors present a treatment algorithm based on their clinical evidence and discuss new basic scientific aspects of treating elbow stiffness. [22] (10.1155/2013/951397)
• [L5] Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament, presenting with clicking, locking, or recurrent dislocation. [23] (10.5435/00124635-200411000-00005)
• [L5] Most simple elbow dislocations are readily managed nonoperatively and are amenable to early mobilization. [24] (10.1016/j.hcl.2020.07.013)
• [L4] However, the available current evidence possesses a high degree of fragility, and further studies are needed with objective measurements to determine the optimal elbow flexion angle for graft fixation. [25] (10.1016/j.jse.2018.07.029)
• [L1] This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. [26] (10.1016/j.injury.2020.11.010)
• [L5] Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced or for unstable periarticular fractures. [27] (10.5435/00124635-199801000-00002)
• [L5] Simple dislocations of the elbow are highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers, allowing for early active range of motion during rehabilitation. [28] (10.1016/j.hcl.2004.07.002)
• [L5] An algorithmic approach to the diagnosis and treatment of complex elbow fracture-dislocation injuries can improve the diagnostic assessment and reconstruction of the bony and ligamentous restraints to restore a stable and functional elbow. [29] (10.5435/jaaos-d-23-00460)
• [L4] Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision, whereas linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss. [30] (10.1016/j.hcl.2007.11.002)
• [L4] The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. [31] (10.1016/j.jse.2019.11.021)
• [L5] The Wrightington classification of elbow fracture dislocation is a comprehensive, reliable, and valid classification with treatment algorithms that are associated with good functional outcomes. [32] (10.1016/j.jseint.2022.12.002)
• [L5] Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases. [33] (10.1136/jisakos-2019-000316)
• [L4] PLRI of the elbow remains to be fully understood. [34] (10.1016/j.arthro.2014.02.029)
• [L4] Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve. [35] (10.1016/j.arthro.2009.04.024)
• [L5] A stiff, congruent elbow is preferable to an unstable elbow. [36] (10.1016/j.hcl.2017.09.008)
• [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. [38] (10.1136/jisakos-2021-000614)
• [L5] Elbow valgus instability in the throwing athlete may be managed either nonsurgically or surgically. [39] (10.5435/00124635-200611000-00014)
• [L4] The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. [40] (10.1016/j.xrrt.2023.12.004)
• [L4] Athletes with elbow dislocation demonstrated excellent functional outcomes and high return to sport rates, with most returning within 10 weeks. [41] (10.1177/23259671261419505)
• [L5] Simple elbow dislocations should be managed with early range of motion, as most do not require surgery. [42] (10.1016/j.hcl.2016.08.003)
• [L1] Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. [43] (10.1186/s12891-024-07260-0)
• [Case_report] This case should sensitize the readers for concomitant vascular lesions when confronted with elbow dislocations. [44] (10.1007/s00167-010-1202-5)
• [Case_report] Proximal radioulnar translocation with radial neck fracture and elbow dislocation is an extremely rare injury in children that requires careful radiographic evaluation to avoid delayed diagnosis. [46] (10.1007/s00402-013-1820-8)
• [L5] The prognosis for simple dislocations is better than for complex dislocations, and prolonged immobilization is associated with unsatisfactory results. [47] (10.1016/j.csm.2004.04.014)

References

[1] Complex Elbow Instability. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.010

[2] Elbow Instability in Children. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.007

[3] The role of arthroscopy in instability of the elbow. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.001

[4] Elbow Dislocation and Subluxation Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117750105

[5] Simple Elbow Dislocation. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.06.002

[6] The Role of Arthroscopy in Chronic Elbow Instability. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.08.016

[7] Traumatic Elbow Instability. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.002

[8] Simple elbow dislocation. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217694163

[9] Complex instability of the elbow. Injury. 2017. DOI: 10.1016/j.injury.2013.09.032

[10] Lateral Collateral Ligament Instability of the Elbow. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.001

[11] Complex Elbow Instability. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200605000-00003

[12] Terrible Triad Injury of the Elbow: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200903000-00003

[13] Terrible triad injury of the elbow: a spectrum of theories. JSES International. 2023. DOI: 10.1016/j.jseint.2023.03.018

[14] The frequency and risk factors for subsequent surgery after a simple elbow dislocation. Injury. 2015. DOI: 10.1016/j.injury.2015.02.009

[15] Nonacute Treatment of Elbow Fracture with Persistent Ulnohumeral Dislocation or Subluxation. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00817

[16] Acute Dislocations of the Adult Elbow. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.012

[17] Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02933

[18] Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.11.025

[19] Coronoid fractures and traumatic elbow instability. JSES International. 2023. DOI: 10.1016/j.jseint.2023.03.020

[20] Fracture-dislocation of the elbow: diagnosis, treatment, and prognosis. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.06.005

[21] Management of Complex Elbow Dislocations. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00023

[22] Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations. Advances in Orthopedics. 2013. DOI: 10.1155/2013/951397

[23] Posterolateral Rotatory Instability of the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2004. DOI: 10.5435/00124635-200411000-00005

[24] Elbow Instability. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.013

[25] Elbow flexion angle during graft fixation for ulnar collateral ligament reconstruction: a systematic review of outcomes and complications. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.07.029

[26] Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review. Injury. 2022. DOI: 10.1016/j.injury.2020.11.010

[27] Acute Elbow Dislocation: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199801000-00002

[28] Simple dislocations of the elbow: evaluation and treatment. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.07.002

[29] Complex Elbow Fracture-Dislocations: An Algorithmic Approach to Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00460

[30] Instability After Total Elbow Arthroplasty. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.002

[31] Chronic complex persistent elbow instability: a consecutive and prospective case series and review of recent literature. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.021

[32] “How the Wrightington classification of traumatic elbow instability can simplify the algorithm for treatment”. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.002

[33] Treatment of elbow instability: state of the art. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2019-000316

[34] Surgical Treatment of Posterolateral Rotatory Instability of the Elbow. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.029

[35] Is Elbow Arthroscopy Safe in Patients with a Subluxating ulnar nerve or Previous Ulnar Nerve Transposition? (SS‐24). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.024

[36] Elbow Fractures with Instability. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.09.008

[38] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[39] Elbow Valgus Instability in the Throwing Athlete. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200611000-00014

[40] Comparing internal and external stabilization for traumatic elbow instability: a systematic review. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2023.12.004

[41] Return to Sport Following Elbow Dislocation: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261419505

[42] Elbow Dislocations in Contact Sports. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2016.08.003

[43] Treatment strategies for simple elbow dislocation - a systematic review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07260-0

[44] Brachial artery transection caused by closed elbow dislocation in a mature in‐line skater: a case report with review of the literature. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1202-5

[46] Proximal radioulnar translocation associated with elbow dislocation and radial neck fracture in child: a case report and review of literature. Archives of Orthopaedic and Trauma Surgery. 2013. DOI: 10.1007/s00402-013-1820-8

[47] Elbow dislocations in adults and children. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.014