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 login to view 1 more bullet 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 login to view 2 more bullets 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 login to view 2 more bullets poor soft-tissue coverage metal hypersensitivity skeletally immature patient inability to comply with postop restrictions or planned implant removal Anatomy Osteology distal humerus login to view 1 more bullet proximal ulna login to view 2 more bullets proximal radius login to view 1 more bullet Muscles flexors login to view 2 more bullets extensors login to view 1 more bullet Ligaments medial collateral ligament (mcl) complex lateral collateral ligament (lcl) complex Nerves ulnar nerve login to view 1 more bullet median nerve radial nerve Blood supply brachial artery login to view 1 more bullet periarticular anastomosis login to view 3 more bullets Preoperative Planning imaging x-rays login to view 3 more bullets CT scan login to view 2 more bullets 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 login to view 2 more bullets 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 login to view 1 more bullet 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 login to view 1 more bullet 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 login to view 1 more bullet axis pin removal login to view 1 more bullet locating the base plate login to view 1 more bullet exposing the base plate login to view 1 more bullet compression screw removal login to view 1 more bullet construct removal login to view 2 more bullets 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