Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study

Abstract

BackgroundConservative treatment of simple elbow dislocations can lead to complications such as persisting pain and restricted joint mobility. The current aim was to identify patients with deteriorated outcome after conservative treatment and to investigate a possible association with initial joint (in)stability.MethodsSixty-eight patients (mean age 37.1 ± 17.2 years) with simple elbow dislocations received conservative treatment. After closed reduction, joint stability was tested by varus and valgus stress under fluoroscopy. According to the findings under fluoroscopy, three different groups of instability could be identified: (1) slight instability (joint angulation <10°; n = 49), (2) moderate instability (angulation ≥10°; n = 19) and (3) gross instability. Patients with gross instability (re-dislocation under stability testing) were treated with primary surgical ligament repair and therefore excluded from this study. Additionally, MRIs and radiographs were analysed regarding warning signs of instability such as the drop sign and joint incongruence. Main outcome parameters were the Mayo Elbow Performance Score (MEPS), range of motion (ROM), complications and revision rates.ResultsAfter 40.7 ± 20.4 months, the overall MEPS was excellent (94.2 ± 11.3) with a trend of slightly worse clinical results in group 2 (95.8 ± 9.0 vs. 90.0 ± 15.2 points; p = 0.154). In group 1, significantly more patients achieved an excellent result regarding the MEPS scoring system (77.6 vs. 52.6 %; p = 0.043) and elbow extension was significantly worse in group 2 (5.3 ± 9.9° vs. 1.4 ± 3.0°; p = 0.015). Seven treatment complications occurred in group 2 (36.8 %) compared with two in group 1 (4.1 %, p < 0.0001). Six patients (8.8 %) needed secondary surgery with an 8.4-fold higher risk for revision surgery in group 2 (p = 0.007). The presence of a positive drop sign or joint incongruence led to higher odds ratio (OR) for complications (OR = 15.9) and revision surgery (OR = 10.3).ConclusionsThis study demonstrates that patients with moderate joint instability after simple elbow dislocation have a significantly worse clinical outcome, more complications and a higher need for secondary revision surgery following conservative treatment compared to patients with slight elbow instability.

Functional outcomes and complications of open elbow dislocations

“…Elbow dislocations can be divided into simple dislocations with pure ligamentous injuries and complex dislocations with concomitant fractures of the radial head, olecranon, coronoid, or the distal humerus [ 9 ]. The majority of simple elbow dislocations are stable after reduction and can be treated by functional rehabilitation of the elbow [ 3 , 6 , 12 ]. Complex elbow instabilities are characterized by periarticular fractures with damage to the articular surface and require surgical repair [ 8 ].…”

Anterior elbow dislocation without fracture in an adult: a rare injury pattern

“…It is extremely important that on-table stability check should be done under anaesthesia and confirmed with fluoroscopy 4 15. A widening of more than 1 mm at the ulno-humeral joint (between distal humeral joint line and the proximal ulno-radial joint line) during valgus stress test is considered as subtle valgus instability 1. Widening of over 1.5 mm at the radio-capitellar joint on varus stress testing is considered as subtle varus instability.…”

“…Widening of over 1.5 mm at the radio-capitellar joint on varus stress testing is considered as subtle varus instability. Mild and moderate instability are determined by angular displacement of <10 0 (mild) or >10 0 (moderate) on stress testing 1 3. If the joint re-dislocates, it signifies severe instability.…”

“…Elbow joint is the second most common joint to dislocate in the body 1–3. Majority of elbow dislocations are posterior and very few are anterior (0%–2.6%) 4 5.…”

Diagnostik und Therapie der akuten und chronischen Ellenbogeninstabilität

“…Diese Terminologie ist irreführend, da es sich bei der "einfachen" Luxation in der Regel um komplexe Weichteilverletzungen handelt [4]. Manche Autoren schließen knöcherne Bandausrisse des lateralen und medialen Epi-kondylus und Koronoidspitzenfrakturen vom Typ I nach Regan und Morrey in die Definition der einfachen Ellenbogenluxation mit ein [3,27].…”