A Comparative Study of Conservative Functional Treatment versus Acute Ligamentous Repair in Simple Dislocation of the Elbow in Adults

Krtička, Milan; Ira, Daniel; Flek, Martin; Švancara, Jan; Pikula, Radek

doi:10.4103/ortho.ijortho_578_16

Cited by 5 publications

(16 citation statements)

References 23 publications

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“…Nevertheless, residual PLRI can also lead to a subjective feeling of instability and therefore affecting the subjective results. Last but not least, the follow-up rate was quite low but the sample size is comparable to already published studies[ 10 , 13 ]. Nevertheless, there are certain strengths of the present study including an a priori power calculation and a mid-term follow-up of 61.5 months, as well as the objective measurements of joint stability by ultrasound in a standardized fashion.…”

Section: Discussionsupporting

confidence: 76%

“…This is in agreement with the results of the present study with regard to ROM but we recognized a higher complication rate for the ST group. More recent studies reveal a generally high patient satisfaction after simple elbow dislocation, regardless of the treatment [ 3 , 12 , 13 , 27 ]. The authors agree, thus 95.5% of the patients achieved “excellent” outcome according to the MEPS.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the sample size and a missing control group are limiting the authors’ conclusion that anatomical ligamentous healing does not exist after conservative treatment. In a comparative study evaluating conservative vs. surgical treatment after simple elbow dislocation in 54 patients, Krticka et al [ 13 ] conclude that conservative treatment ( n = 28) when applied at stable elbows (no re-instability within the arc of motion of 45°–120°) leads to statistically better results in terms of ROM and scores such as the MEPS, Oxford elbow score (OES) and the Quick-DASH. The MEPS reached 97 points (range:75–100) for conservative and 87.7 points (range: 60–100) for surgical treatment, whereas the Quick-DASH was 2.5 (range: 0–13.6) and 8.3 (0–27.3), respectively.…”

Section: Discussionmentioning

confidence: 99%

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Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment

Geyer

Lacheta

Aspang

et al. 2022

Arch Orthop Trauma Surg

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Purpose While conservative management is commonly promoted for simple elbow dislocations, the importance of primary surgical treatment in these injuries is still undetermined. The objective of this study was to report patient-reported outcome measures (PROMs), return to sports (RTS) and joint stability using ultrasound in patients following conservative or surgical treatment after simple elbow dislocation. Methods Patients with a minimum follow-up of 24 months after conservative (CT) or surgical treatment (ST) following simple elbow dislocation were included in this retrospective study. To evaluate patients’ postoperative outcome and satisfaction, the Elbow Self-Assessment Score (ESAS) was used, and validated scores such as the Mayo elbow performance score (MEPS), the Quick Disability of Arm and Shoulder Score (Quick-DASH) and RTS were assessed. For objective assessment of residual joint instability, a standardized clinical examination as well as a dynamic ultrasound evaluation of the affected and the contralateral elbow was performed. Results Forty-four patients (26 women, 18 men) with an average age of 41.5 ± 15.3 years were available for follow-up survey (65.5 ± 30.4 months; range 26–123). 21 patients were treated conservatively and twenty-three patients received surgical treatment. CT and ST resulted in similar outcome with regard to ROM, ESAS (CT: 99.4 ± 1.5; ST: 99.8 ± 0.3), MEPS (CT: 97.3 ± 6.8 points; ST: 98.7 ± 3.3) and Quick-DASH (CT: 7.8 ± 10.4; ST: 6.3 ± 7.9) (n.s.). There was no difference in elbow stability and laxity measured by ultrasound between the study groups and compared to the healthy elbow (n.s.). Two patients of the CT group (10%) complained about persistent subjective elbow instability. RTS was faster after surgical compared to conservative treatment (p = 0.036). Conclusion Both, conservative and surgical treatment results in high patient satisfaction and good-to-excellent functional outcome after simple elbow dislocation. Even though ultrasound evaluation showed no significant differences in joint gapping between groups, 10% of conservatively treated patients complained about severe subjective instability. Surgically treated patients returned faster to their preoperatively performed sports. Thus, primary surgical treatment may be beneficial for high demanding patients. Level of evidence Therapeutic study, Level III.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment

Geyer

Lacheta

Aspang

et al. 2022

Arch Orthop Trauma Surg

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“…An overview of the outcomes is presented in Table I for nonoperative treatment and for surgical treatment in Table II. The ROM was reported in 21 studies 8,13,19-37 . PROMs were reported in 24 studies 5,8,13,18-27,29,30,33-35,37-42 .…”

Section: Resultsmentioning

confidence: 99%

Treatment Outcomes of Simple Elbow Dislocations

Pott,

de Klerk,

Priester-Vink

et al. 2024

JBJS Reviews

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Background: The treatment of simple elbow dislocations (SEDs) has become more functional last decade with a tendency to shorter immobilization of the elbow, whereas simultaneously, surgical stabilization has been promoted by some authors. The primary aim of this study was to systematically review the literature and analyze the outcomes and complications of different treatment options for acute and persistent SEDs, including operative and nonoperative treatments with varying immobilization periods. Methods: A literature search was performed based on the online medical databases MEDLINE, Embase, and the Cochrane databases. Articles presenting patients with a SED were eligible for inclusion. When an SED persists for >3 weeks, it is categorized as persistent. Various outcome measures were assessed, including the range of motion (ROM), patient-reported outcome measures, and complication rates. To get insight into the severity of complications, all complications were categorized as minor or major. The Methodological Index for Nonrandomized Studies was used to assess the methodological quality of nonrandomized studies. The risk of bias in the randomized studies was assessed with the Cochrane risk-of-bias tool. Results: A total of 37 articles were included with 1,081 dislocated elbows (1,078 patients). A fair quality of evidence was seen for the nonrandomized studies and a low risk of bias for the randomized study. Nonoperative treatment was administered to 710 elbows, with 244 elbows treated with early mobilization, 239 with 1- to 3-week immobilization, and 163 with ≥3-week immobilization. These groups showed a ROM flexion-extension arc (ROM F/E) of 137, 129, and 131°, respectively. Surgical treatment as open reduction and ligament repair or reconstruction was performed in 228 elbows and showed a ROM F/E of 128°. All persistent SEDs were treated surgically and showed a ROM F/E of 90°. Conclusion: The early mobilization treatment showed the most consistent satisfactory outcomes in the literature compared with the other treatment options. Nevertheless, there remains ambiguity regarding which patients would benefit more from surgery than nonoperative treatment. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…A total of 15 papers were included for analysis after title, abstract, and full-text screen (Figure 1). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of the 15 included studies, 3 studies were level II 22,23,25 or higher while 12 studies were level II or lower [16][17][18][19][20][21]24,[26][27][28][29][30] (Table 1). Of the studies level II or greater, the mean sample size was 60 patients (range 50-100), with a pooled total of 210 cases of simple elbow dislocations.…”

Section: Study Strategy and Characteristicsmentioning

confidence: 99%

Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review

et al. 2020

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Purpose This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period.

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A Comparative Study of Conservative Functional Treatment versus Acute Ligamentous Repair in Simple Dislocation of the Elbow in Adults

Cited by 5 publications

References 23 publications

Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment

Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment

Treatment Outcomes of Simple Elbow Dislocations

Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review

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