Simple dislocation of the elbow in the adult. Results after closed treatment.

Mehlhoff, Thomas L.; Noble, Phil; Bennett, James B.; Tullós, Hugh S.

doi:10.2106/00004623-198870020-00013

Cited by 346 publications

(174 citation statements)

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“…Moreover, ligamentous repair may not be sufficient to stabilize the elbow in such a way that immediate active movement is tolerated [5,28]. Plaster immobilization is unattractive, because earlier studies found that mobilization is essential during healing of injured ligaments because the functional load on the collagen fibers prevents contracture and the risk of stiffness [1,11,17,20,27,29,37]. Another alternative is the hinged external fixator, which stabilizes the elbow and protects the elbow against valgus and varus stress and allows flexion and extension.…”

Section: Introductionmentioning

confidence: 99%

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

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Section: Introductionmentioning

confidence: 99%

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

Iordens

Hartog

Lieshout

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Simple elbow dislocations treated with early mobilization after closed reduction usually have good functional results despite the capsuloligamentous stabilizers of the articulation of the elbow being ruptured [19]. Complex elbow dislocations are when a simple elbow dislocation is associated periarticular fracture [13].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Simple and Complex Open Elbow Dislocations

Boretto

Sammartino

Gallucci

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Open elbow dislocations are rare injuries. Most of the evidence related to these dislocations is found in case reports or in series with closed injuries. We reviewed the experiences of three centers in the treatment of open elbow dislocations. Question/purposes We compared the results after operative treatment of simple and complex open dislocations in terms of (1) ROM, (2) functional score, and (3) complications. Methods Eighteen patients were retrospectively included in this study: 11 with simple open elbow dislocations and seven with complex open elbow dislocations. Mean age was 40 years. Thirteen were men. Eight patients presented neurovascular injuries. Evaluation included ROM of the elbow and forearm as measured by hand-held goniometer. We then classified the results using the 100-point Broberg and Morrey functional rating index based on ROM, grip strength, elbow stability, and pain. Scores of 95 to 100 were considered excellent, 80 to 94 good, 60 to 79 fair, and less than 60 poor. Complications were recorded. Minimum followup was 6 months (mean, 25 months; range, 6-72 months). Results We found no differences between simple and complex open elbow dislocations related to ROM (median flexion/extension: 117°versus 110°, p = 0.12; forearm rotation: 160°versus 170°, p = 0.67). According to the Broberg and Morrey score, four patients had excellent results, five good, and one fair in the simple dislocation group, whereas in the complex dislocation group, four patients had excellent results, two good, and one fair (p = 0.8). No difference in complication rate was found between groups (p = 0.63). All complications in the simple dislocation group were neurovascular. In the complex dislocation group, there was one case of brachial artery occlusion, two cases of heterotopic ossification, one case of infection and nonunion, and one case of infection. No patients had recurrent elbow instability.

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“…16 Major traumas such as motor vehicle accidents can also cause these injuries. 15,18 The most common cause of an elbow dislocation is a fall on the elbow or outstretched hand from standing height 4,14,19 or higher. 4,15,[18][19][20][21][22][23] The specific mechanisms of coronoid fracture (and elbow dislocation) are varied and can involve twisting and flexion, as well as hyperextension.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…15,18 The most common cause of an elbow dislocation is a fall on the elbow or outstretched hand from standing height 4,14,19 or higher. 4,15,[18][19][20][21][22][23] The specific mechanisms of coronoid fracture (and elbow dislocation) are varied and can involve twisting and flexion, as well as hyperextension. 5,10,22,24,25 When the elbow is axially loaded in extension, force is concentrated on the articular surface of the coronoid process.…”

Section: Mechanism Of Injurymentioning

confidence: 99%