Elbow Joint Stability and Injury Management

The elbow is a complex hinge joint whose stability arises from the interplay of bony congruity, primary ligaments and muscular support. The ulnohumeral articulation, reinforced anteriorly by the coronoid process and laterally by the radial head, provides primary static stability, while the medial ulnar collateral ligament (MUCL) and lateral ulnar collateral ligament (LUCL) resist valgus and varus stresses respectively. Dynamic stabilisers, including the anconeus and triceps brachii muscles, fine-tune joint kinematics during motion. Injury mechanisms range from simple dislocations, managed conservatively with early mobilisation, to complex fracture–dislocations such as the “terrible triad” combining ulnohumeral dislocation with coronoid and radial head fractures. Surgical intervention centres on restoring articular congruity and soft-tissue tension through techniques such as open reduction and internal fixation, ligament reconstruction or radial head replacement. Early functional rehabilitation minimises stiffness, whereas accurate assessment of joint stability—often aided by advanced imaging—guides the need for operative repair. Recent advances emphasise refined fixation devices and diagnostic criteria to reduce complication rates and improve long-term function.

Research from Nature Portfolio

A novel Lasso-plate fixation technique for Regan–Morrey type I and II coronoid fractures in the context of the terrible triad has demonstrated superior clinical outcomes compared with conventional open reduction and internal fixation. In a multicentre cohort, this method yielded shorter operative times, a lower incidence of heterotopic ossification and joint stiffness, and improved range of motion and performance scores at one-year follow-up, supporting its adoption for reliable fragment stabilisation and enabling earlier rehabilitation.

Elbow Joint Stability and Injury Management publication trend

The graph below shows the total number of articles in elbow joint stability and injury management across all publications each year (not limited to Nature Index journals).

Technical terms

Coronoid process: A triangular eminence on the anterior ulna that prevents posterior translation of the ulna on the humerus.

Radial head: The proximal end of the radius that articulates with the capitellum and contributes to valgus stability and load transfer.

Lateral ulnar collateral ligament (LUCL): A key lateral ligament that resists posterolateral rotatory forces and maintains joint congruence.

Posterolateral rotatory instability (PLRI): A condition in which the forearm and hand rotate supinely under the humerus, often due to LUCL insufficiency.

Radiocapitellar line (RCL): A radiographic reference drawn through the centre of the radial neck and head to assess alignment with the capitellum, used in instability evaluation.

References

1. Func tional treatment versus plaster for si mple el bow dislocations (FuncSiE): a randomized trial. BMC Musculoskeletal Disorders (2010).
2. Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study. Journal of Orthopaedic Surgery and Research (2015).
3. Complex Elbow Dislocations and the “Terrible Triad” Injury. The Open Orthopaedics Journal (2017).
4. A novel and superior Lasso-plate technique in treatment for coronoid process fracture in the terrible triad of elbow. Scientific Reports (2023).
5. Outcomes of coronoid-first repair through an anterior approach in patients with terrible triad injury of the elbow: a prospective study with a minimum 2-year follow-up. Journal of Orthopaedics and Traumatology (2024).
6. The HuRaA Trial—The Radiocapitellar Line Shows Significant Posterior Translation in Healthy Elbows: A Prospective Analysis of 53 Healthy Individuals. Biomedicines (2024).
7. LUCL reconstruction of the elbow: clinical midterm results based on the underlying pathogenesis. Archives of Orthopaedic and Trauma Surgery (2021).