The results of conservatively treated simple elbow dislocations

Abstract

Objectives: Closed reduction followed by short-time immobilization is the generally accepted treatment for simple elbow dislocations. However, the number of studies concerning the results of this method is limited. In this study, the clinical and radiographic results of conservatively treated simple elbow dislocations were retrospectively evaluated.
Methods: The study included 21 patients (16 males, 5 females) who underwent closed reduction and immobilization for simple elbow dislocations. Simple dislocations were defined as non-fracture dislocations and dislocations accompanied by minor avulsion fractures that did not require additional surgery or immobilization. The mean age of the patients at the time of injury was 35 years (range 16 to 59 years). All the patients had posterior dislocations. Eleven patients (52.4%) had minor avulsion fractures. Following closed reduction, a plaster splint and hinged brace were used in four (19.1%) and 17 (81%) patients, respectively. Incremental active and passive motions were started at the end of the first week in patients in whom a brace was used. The mean duration of brace use was 27±16 days. Patients using a plaster splint were immobilized for three weeks. The patients were assessed clinically with respect to range of motion, instability, and neurologic findings after a mean follow-up period of 34 months (range 12 to 99 months). Functional assessments included the Mayo Elbow Performance Score (MEPS) and the Broberg-Morrey Functional Rating Index (BMFRI). Standard elbow anteroposterior and lateral radiographs were examined for concentric reduction and signs of degeneration and heterotopic ossification.
Results: Compared to the normal side, the degrees of flexion, extension, flexion arc, and pronation were significantly decreased in dislocated elbows (p<0.05), while the degrees of supination and rotational arc were similar. There was no muscular atrophy. Four patients (19.1%) had residual instability and six patients (28.6%) had mild to moderate neurological complaints that were primarily related to the ulnar nerve. Three patients complained of mild pain, and one patient complained of moderate pain at rest. Radiographic assessment showed mild degeneration in three patients (14.3%), and mild to moderate heterotopic ossification in 14 patients (66.7%). Patients with and without heterotopic ossification did not differ significantly with respect to the values of joint range of motion. The mean MEPS and BMFRI scores were 96.9 and 97.7, respectively. The scores of both systems were excellent in 20 patients (95.2%) and moderate in one patient (4.8%). The majority of the patients (81%) reported complaints about their elbows including sensation of stiffness in the elbow, pain during strenuous work or sports activities, and limitation of movement. Only four patients (19.1%) reported a feeling of full recovery.
Conclusion: Although closed reduction with short-term immobilization is a universally accepted method for simple elbow dislocations with excellent functional scores, it is associated with significant limitations in joint movements and a great majority of patients do not consider themselves fully recovered.

Keywords

• Dislocations/therapy/complications
• elbow joint/injuries
• joint instability