Summary The Skeletal Dynamics Distal Elbow System consists of the following systems Proximal Ulna Plate with FREEFIX® ALIGN® Radial Head System IJS® Elbow Stabilization System (this page) The IJS® Elbow Stabilization System is a temporary internal joint stabilizer designed to manage unstable elbows after trauma or chronic dislocation It allows early range of motion while protecting fracture and ligament repairs, acting as an adjunct to definitive reconstruction rather than a standalone solution Biological Materials Titanium alloy ulnar base plate humeral axis pin Stainless steel connecting rod and fixation components Material properties biocompatible high strength and fatigue resistance corrosion resistant compatible with temporary internal fixation Indications Indications acute elbow instability fracture-dislocations terrible triad injuries chronic or recurrent elbow dislocation persistent instability after orif and/or ligament repair adjunct to soft-tissue reconstruction to allow early rom alternative to hinged external fixation for unstable elbows Contraindications active infection inadequate bone stock 30% distal humerus articular bone loss ≥50% coronoid deficiency poor soft-tissue coverage metal hypersensitivity skeletally immature patient inability to comply with postop restrictions or planned implant removal Anatomy Osteology distal humerus trochlea and capitellum form elbow hinge axis proximal ulna olecranon coronoid process proximal radius radial head contributes to valgus and axial stability Muscles flexors biceps brachii brachialis extensors triceps brachii Ligaments medial collateral ligament (mcl) complex lateral collateral ligament (lcl) complex Nerves ulnar nerve posterior to medial epicondyle median nerve radial nerve Blood supply brachial artery primary arterial inflow periarticular anastomosis radial recurrent artery ulnar recurrent arteries profunda brachii branches Preoperative Planning imaging x-rays ap, lateral, and oblique elbow views assess joint congruency and fracture pattern evaluate coronoid and radial head integrity CT scan indicated for complex fracture-dislocations evaluate coronoid fracture size and location Approach Incision midway between the epicondyle and the olecranon Exposure lateral approach to the elbow joint through the surgeon’s preferred muscle interval Technique Center of rotation locate and mark the anatomic center on the lateral capitellum note this is identified as the center of a circle that fits the curvature of the capitellum on the lateral view full visualization of the lateral epicondyle to the capitellum is critical to accurately establish the anatomic center of rotation. Axis guide sizing open the joint by applying a varus stress allowing access to insert the largest sized Axis Guide that is appropriate for the patient the handle of the Axis Guide should be positioned in-line with the humeral shaft and into the trochlear notch, engaging the medial trochlear expansion note there are three sizes of Axis Guides available Guide wire attachment insert the K-wire Guide into the Axis Guide so that it is close to the lateral epicondyle without making contact, and then rotate it clockwise to lock it in place Guide wire insertion advance the Guide-Wire (1.5mm K-wire) through the K-wire Guide and into the humerus, stopping short of the medial cortex caution DO NOT violate the medial cortex as it may result in ulnar nerve injury Axis guide removal remove the entire assembly leaving the Guide Wire (1.5mm K-wire) in place Fluoroscopic confirmation confirm that the Guide Wire (1.5mm K-wire) has been inserted to the correct depth and that the axis of rotation has been properly established using fluoroscopy Axis pin measurement place the Depth Gauge over the Guide Wire (1.5mm K-wire) to measure the drilling depth for the proper length of Axis Pin if between sizes, choose a shorter length Base plate positioning position the Base Plate on the proximal aspect of the ulna Base plate drilling drill for bicortical fixation through the sliding slot on the Base Plate using the 2.7mm drill bit, aiming towards the coronoid process and away from the radial notch measure using the Depth Gauge for the appropriate length 3.5mm compression screw (Polyaxial Non Locking) Axis pin measurement insert the corresponding 3.5mm compression screw (Polyaxial Non Locking) using the T-10 Driver repeat past two steps for the remaining two compression screw holes of the Base Plate Construct alignment if the head of the Proximal Locking Screw or the arrow of the Distal Locking Joint are NOT pointing proximally loosen the Distal Locking Screw and remove the Distal Connecting Rod to flip the Distal Locking Joint 180° so that its arrow is pointing proximal then reinsert the Distal Connecting Rod back into the Distal Locking Joint with the Proximal Locking Screw also pointing proximal Inserting the axis pin adjust the Distal Connecting Rod to allow the selected Axis Pin to be inserted through the eyelet of the Proximal Connecting Rod and into the humerus Locking the axis pin use the PROTEAN Pliers to stabilize the Proximal Connecting Rod while fully tightening the Axis Pin using the T-10 Driver Elbow reduction anatomically reduce the elbow joint Locking the construct using the T-10 Driver and the Counter Torque Tool, lock the reduction by first tightening the Proximal Locking Screw and then the Distal Locking Screw Final fluoroscopic confirmation confirm that the reduction is maintained through the full ROM using fluoroscopic imaging Trimming the connecting rod using a pin cutter, remove any excess length from the Distal Connecting Rod that exits the Distal Locking Joint Deep closure reattach the origin of the lateral collateral ligament and the origin of the extensor muscle just proximal to the Axis Pin Locking the construct close the incision in the usual fashion Explanting procedure locating the axis pin palpate the lateral epicondyle to locate and mark the head of the Axis Pin axis pin removal make a stab incision over the marked area and remove the Axis Pin using the T-10 Driver locating the base plate palpate the posterior surface of the ulna to locate and mark the position of the Base Plate exposing the base plate make an incision to expose the Base Plate compression screw removal using the T-10 Driver, remove the three 3.5mm compression screws construct removal remove the Base Plate construct close both incisions and dress the wounds in the usual fashion Screws IJS® Elbow System IJS® Elbow System Cortical Non Locking 3.5mm x (16mm, 18mm, 20mm, 22mm, 24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 38mm, 40mm, 42mm, 44mm) Axis Pin 2.5mm x (30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 65mm, 70mm) Pearls & Pitfalls Pearls restore osseous stability (coronoid, radial head) before ijs placement repair collateral ligaments prior to device implantation identify the true center of rotation of the elbow using fluoroscopy place humeral axis pin coaxial with the ulnohumeral joint Pitfalls using product in the setting of inadequate bone stock failure to address coronoid or radial head deficiency inadequate fixation of the ulnar base plate patient noncompliance with rehabilitation protocol