Clinical and functional outcomes of pediatric elbow dislocations: Level 1 tertiary trauma center experience

Abstract

Background/Aim: Traumatic elbow dislocations have been reported as uncommon in pediatric population. Because of low frequency, there are not many studies on the subject in the literature. The aim of this study was to retrospectively evaluate the radiological and functional results of pediatric patients treated for elbow dislocations in a level-1 tertiary trauma center and to compare the results of simple and fractured dislocations. Methods: This is a retrospective cohort study of a single center experience diagnosed with pediatric elbow dislocations between 2015 and 2019. The cases were evaluated by dividing them into two groups as simple dislocations and fracture dislocations. Demographic features, injury mechanism, treatment, complications and Mayo elbow performance score (MEPS) were evaluated. Results: Fifty-seven patients, (46 male/ 11 female), were included in the study, with a mean age of 11.1 (3-15) years. Mean follow up time was 27.2 (12-51) months. While 30 patients had fracture dislocations, 27 patients had simple dislocations. Of 30 patients with fracture dislocations, 19 were operated. Nonunion in the medial epicondyle in five patients, AVN (avascular necrosis) in radial head in two patients, heterotrophic ossification in one triceps, and recurrent dislocation in one patient were detected. According to MEPS, 42 (73%) of 57 patients were excellent, 12 (21%) good, one (2%) moderate, and two (4%) poor. According to MEPS, functional results of simple dislocations were found to be better than those of fracture-dislocations, and this result was statistically significant (P<0.05). Conclusion: Elbow dislocations in children can be treated with good results if they are accurately diagnosed and if concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures can be achieved. Simple dislocations are easier to manage and functional results are better, whereas the treatment of fractured dislocations is more complex and complications are more common in follow-up.

Keywords

• Pediatric elbow dislocation
• Simple dislocation
• Fracture dislocation
• Complication
• MEPS

References

1. 1. Wilkins KE. Fractures and dislocations of the elbow region. In: Rockwood CW, King RE, editor. Lipponcott-Raven1996. p. 653–887.
2. 2. Sinikumpu JJ, Lautamo A, Pokka T, Serlo W. Complications and radiographic outcome of children's both-bone diaphyseal forearm fractures after invasive and non-invasive treatment. Injury. 2013;44(4):431-6.
3. 3. Von Laer L. Pediatric fractures and dislocations. Pediatric fractures and dislocations. Stuttgart, Germany: Thieme; 1st edition; 2004. p. 528.
4. 4. Lieber J, Zundel SM, Luithle T, Fuchs J, Kirschner HJ. Acute traumatic posterior elbow dislocation in children. Journal of pediatric orthopedics Part B. 2012;21(5):474-81.
5. 5. Rasool MN. Dislocations of the elbow in children. The Journal of bone and joint surgery British volume. 2004;86(7):1050-8.
6. 6. Kirkos JM, Beslikas TA, Papavasiliou VA. Posteromedial dislocation of the elbow with lateral condyle fracture in children. Clinical orthopaedics and related research. 2003(408):232-6.
7. 7. Murphy RF, Vuillermin C, Naqvi M, Miller PE, Bae DS, Shore BJ. Early Outcomes of Pediatric Elbow Dislocation-Risk Factors Associated With Morbidity. Journal of pediatric orthopedics. 2017;37(7):440-6.
8. 8. Lawrence JT, Patel NM, Macknin J, Flynn JM, Cameron D, Wolfgruber HC, et al. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. The American journal of sports medicine. 2013;41(5):1152-7.

9. 9. Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children. 35-year follow-up of 56 unreduced cases. Acta orthopaedica Scandinavica. 1986;57(4):313-5.
10. 10. Pring ME. Pediatric radial neck fractures: when and how to fix. Journal of pediatric orthopedics. 2012;32 Suppl 1:S14-21.
11. 11. BF M. Functional evaluation of the elbow. In: Morrey BF AK CE, editor. WB Saunders1993. p. 86–9.
12. 12. Reed MW, Reed DN. Acute ulnar nerve entrapment after closed reduction of a posterior fracture dislocation of the elbow: a case report. Pediatric emergency care. 2012;28(6):570-2.
13. 13. Carlioz H, Abols Y. Posterior dislocation of the elbow in children. Journal of pediatric orthopedics. 1984;4(1):8-12.
14. 14. Hughes M, Dua K, O'Hara NN, Brighton BK, Ganley TJ, Hennrikus WL, et al. Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. Journal of pediatric orthopedics. 2019;39(8):e592-e6.
15. 15. Pathy R, Dodwell ER. Medial epicondyle fractures in children. Current opinion in pediatrics. 2015;27(1):58-66.
16. 16. Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. The Journal of the American Academy of Orthopaedic Surgeons. 2012;20(4):223-32.
17. 17. Patrick J. Fracture of the medial epicondyle with displacement into the elbow-joint. The Journal of bone and joint surgery American volume. 1946;28:143-7.
18. 18. Newman JH. Displaced radial neck fractures in children. Injury. 1977;9(2):114-21.
19. 19. Roberts PH. Dislocation of the elbow. The British journal of surgery. 1969;56(11):806-15.
20. 20. Schmittenbecher PP. What must we respect in articular fractures in childhood? Injury. 2005;36 Suppl 1:A35-43.
21. 21. Gausepohl T, Mader K, Kirchner S, Pennig D. The "floating forearm" injury in a child: a case report. Strategies in trauma and limb reconstruction. 2007;2(1):48-54.
22. 22. Schmittenbecher PP, Haevernick B, Herold A, Knorr P, Schmid E. Treatment decision, method of osteosynthesis, and outcome in radial neck fractures in children: a multicenter study. Journal of pediatric orthopedics. 2005;25(1):45-50.
23. 23. Sofu H, Gursu S, Camurcu Y, Yildirim T, Sahin V. Pure elbow dislocation in the pediatric age group. International orthopaedics. 2016;40(3):541-5.
24. 24. Linscheid RL, Wheeler DK. Elbow dislocations. Jama. 1965;194(11):1171-6.
25. 25. Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clinical orthopaedics and related research. 1980(146):42-52.
26. 26. Beaty JH KJ. Elbow dislocations fractures in children. 663–79 p.
27. 27. Royle SG. Posterior dislocation of the elbow. Clinical orthopaedics and related research. 1991(269):201-4.
28. 28. Hopf JC, Berger V, Krieglstein CF, Müller LP, Koslowsky TC. Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results. Journal of shoulder and elbow surgery. 2015;24(2):250-7.
29. 29. Wilmshurst AD, Millner PA, Batchelor AG. Brachial artery entrapment in closed elbow dislocation. Injury. 1989;20(4):240-1.
30. 30. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. The Journal of bone and joint surgery British volume. 1990;72(1):102-4.
31. 31. Di Gennaro GL, Spina M, Fosco M, Antonioli D, Donzelli O. Dislocations of the elbow in children: long-term follow-up. Musculoskeletal surgery. 2013;97 Suppl 1:3-7.
32. 32. Kaziz H, Naouar N, Osman W, Ayeche M. Outcomes of Pediatric Elbow Dislocations. Malaysian orthopaedic journal. 2016;10(1):44-9.
33. 33. Michelsson JE, Rauschning W. Pathogenesis of experimental heterotopic bone formation following temporary forcible exercising of immobilized limbs. Clinical orthopaedics and related research. 1983(176):265-72.