Simple elbow dislocations: Management, direct medical cost and clinical outcome

Abstract

Discussion: MRI is sensitive in detecting ACJ arthritis and Subacromial Impingement but not in identifying the severity of grade. Supraspinatous tear was found in the MRI of 47 patients but only 38 were detected on arthroscopy. 10 of them underwent arthroscopic repair and six of them were unrepairable, remaining 12 patients had delamination or very superficial tear which did not require any repair procedure. MRI detected only four Infraspinatous tear while arthroscopy found 15 Infraspinatous tear. 10 of them underwent repair and five were unrepairable. Arthroscopy is said to be the best means by which SLAP lesions is diagnosed.It allows determination of grade of lesion and its stability. MRI cannot help us decide the grade of lesion and the exact extent of lesion. Although MR imaging is suitable for diagnosing some shoulder disorders, the MR imaging of SLAP lesions and labral tears does not give accurate results.Conclusion: Our study shows that although there is a discrepancy between MRI and arthroscopy in detecting shoulder pathology, MRI is a good investigation as a guide for pre-operative arthroscopic planning.Academic unit of Trauma and Orthopaedics, Leeds Teaching Hospitals, UK Objectives: To evaluate the management, direct-medical-costs and clinical outcome profile of a large trauma unit with respect to simple elbow dislocations.Methods: All simple elbow dislocations that were defined as not requiring acute surgical intervention, postreduction, were considered between January 2008 and December 2010. Inclusion criteria consisted of age greater than 13; absence of major associated fractures, successful closed reduction, and follow-up as an outpatient. The management of these patients was classified in terms of immobilisation time into: short (<2 weeks), standard (2-3 weeks) and prolonged (>3 weeks). Direct-medical-costs were calculated based on current tariff rates associated with radiology, admission, theatre time (for reductions and recovery) and outpatient attendances. Clinical outcome was evaluated with respect to complications, secondary procedures, and time before discharge from clinic.Results: Of 81 patients in total, 6% required reduction in theatre, 17% admission, 9% were referred to a specialist or had a complication and 42% DNA their final appointment. The mean length-of-immobilisation was 2.25 weeks (range 0-6 weeks).The median direct-medical-cost was £893 per patient (range £418-£2693). The median duration of patients' engagement with hospital services was 57 days (range 3-831).There was no statistically significant relationship between length-of-immobilisation and time-before-discharge (p = 0.42), or associated direct-medical-cost (p = 0.586). In terms of clinical outcome the prolonged immobilisation group had a statistically significant worse outcome in comparison to the short (p = 0.30) and the standard (p = 0.01). The comparison between standard immo-bilisation and short resulted in a marginally (p = 0.08) significant advantage of the first.Conclusion: Prolonged elbow immobilisation is genera...