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Elbow instability: Are we able to classify it? Review of the literature and proposal of an all-inclusive classification system

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Abstract

Background

In the recent years, considerable improvements have come in biomechanical knowledge about the role of elbow stabilizers. In particular, the complex interactions among the different stabilizers when injured at the same time have been better understood. Anyway, uncertainties about both nomenclature and classification still exist in the definition of the different patterns of instability.

Material and methods

The authors examine the literature of the last 130 years about elbow instability classification, analyzing the intuitions and the value of each of them. However, because of the lack of a satisfactory classification, in 2015 a working group has been created inside SICSeG (Italian Society of Shoulder and Elbow Surgery) with the aim of defining an exhaustive classification as simple, complete and reproducible as possible.

Results

A new all-inclusive elbow instability classification is proposed. This classification considers two main parameters: timing (acute and chronic forms) and involved stabilizers (simple and complex forms), and four secondary parameters: etiology (traumatic, rheumatic, congenital…), the involved joint (radius and ulna as a single unit articulating with the humerus or the proximal radio-ulnar joint), the degree of displacement (dislocation or subluxation) and the mechanism of instability or dislocation (PLRI, PMRI, direct axial loading, pure varus or valgus stress).

Conclusions

This classification is at the same time complete enough to include all the instability patterns and practical enough to be effectively used in the clinical practice. This classification can help in defining a shared language, can improve our understanding of the disorder, reduce misunderstanding of diagnosis and improve comparison among different case series.

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Acknowledgments

The authors would like to thank for their support and encouragement in developing the classification the SICSeG (Società Italiana di Chirurgia della Spalla e del Gomito) and especially: Graziano Bettelli, Andrea Celli, Maurizio Fontana, Giuseppe Giannicola, PierLuigi Pederzini, Giuseppe Porcellini, Arman Sard.

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Authors and Affiliations

  1. Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Bologna, Italy

    A. Marinelli, E. Guerra & R. Rotini

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  1. A. Marinelli
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  2. E. Guerra
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  3. R. Rotini
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Correspondence to A. Marinelli.

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This article does not contain any studies with animals performed by any of the authors.

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Marinelli, A., Guerra, E. & Rotini, R. Elbow instability: Are we able to classify it? Review of the literature and proposal of an all-inclusive classification system. Musculoskelet Surg 100 (Suppl 1), 61–71 (2016). https://doi.org/10.1007/s12306-016-0424-1

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