Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: A single centre study

Abstract

PurposeTraumatic elbow dislocation (TED) is the most common injury of large joints in children. There is an ongoing debate on the optimal treatment for TED. We aimed to assess the functional outcome after operative and nonoperative treatment of TED.MethodsWe analysed the medical records of patients with TED treated at the University Children’s Hospital, Basel, between March 2006 and June 2015. Functional outcome was assessed using the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Sport and Music Module score. These scores were compared between nonoperatively and operatively treated patients.ResultsA total of 37 patients (mean age 10.2 years, 5.2 to 15.3) were included. Of these, 21 (56.8%) children had undergone nonoperative treatment, with 16 (43.2%) patients having had operative treatment. After a mean follow-up of 5.6 years (1.2 to 5.9), MEPS and QuickDASH Sport and Music Module scores in the nonoperative group and operative group were similar: MEPS: 97.1 points (SD 4.6) versus 97.2 points (SD 2.6); 95% confidence interval (CI)-2.56 to 2.03); p = 0.53; QuickDASH Sport and Music Module score: 3.9 points (SD 6.1) versus 3.1 points (SD 4.6); 95% CI 2.60 to 4.17; p = 0.94. We noted no significant differences regarding the long-term functional outcome between the subgroup of children treated operatively versus those treated nonoperatively for TED with accompanying fractures of the medial epicondyle and medial condyle.ConclusionFunctional outcome after TED was excellent, independent of the treatment strategy. If clear indications for surgery are absent, a nonoperative approach for TED should be considered.Level of evidenceLevel III - therapeutic, retrospective, comparative study

“Unhappy triad” of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes

“…However, it is widely used in the literature as a tool for assessing results after the management of a traumatized elbow in children. 14 , 24 …”

“…Active elbow ranges of motion (ROM) in flexion/extension and pronosupination were recorded with goniometer. Mayo Elbow Performance Score (MEPS) 14 and Quick-Disabilities Of The Arm, Shoulder And Hand (DASH) 15 scores were reported. Standard antero-posterior and profile radiographs of the elbow and forearm were performed for all patients.…”

“…The patient lost to follow-up (Case 20) was removed from the analysis. The mean follow-up was 5.8 ± 5 years (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). At last follow-up (Table 4), mean elbow ROM in flexion, extension, pronation, and supination were of 142° ± 12° (110°-150°), 5° ± 8° (0°-20°), 66° ± 31° (0°-90°) and 56° ± 33° (−10° to 90°), respectively.…”

A Rare Case of Traumatic Bilateral Elbow Dislocation Without a Fracture in a Seven-Year-Old Female Child

“…The management of bilateral elbow dislocation is similar to the treatment of unilateral elbow dislocation. The operative treatment seems to offer no statistically different outcomes in pediatric patients than nonoperative treatment in Mayo Elbow Performance score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Sport and Music Module scores [ 10 ]. A short duration of immobilization is usually recommended to achieve the best results.…”

Fracturas controvertidas de miembro superior en niños y adolescentes: un debate basado en la evidencia

“…Entendiendo estas limitaciones, múltiples autores han reportado resultados similares tanto en pacientes operados como en aquéllos tratados de manera incruenta. [36][37][38][39] Ip y Tsang incluso reportan mejores resultados funcionales en pacientes tratados de manera incruenta utilizando el Mayo Clinic Performance Index que enfatiza en el dolor y las ac-Figura 1: Paciente masculino de 15 años de edad que sufre fractura cerrada diafisaria desplazada de radio y cúbito sin compromiso neurovascular.…”