The Treatment of Simple Elbow Dislocation in Adults

Hackl, Michael; Beyer, Frank; Wegmann, Kilian; Leschinger, Tim; Burkhart, Klaus J.; Müller, Lars Peter

doi:10.3238/arztebl.2015.0311

Cited by 42 publications

(49 citation statements)

References 40 publications

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“…Recently, Hackl et al published a comprehensive review regarding the treatment of simple elbow dislocations. The authors concluded that there is still lack of evidence for the individual treatment decision of simple elbow dislocations [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…A closed dislocation with or without a neurovascular impairment should be followed by immediate closed reduction of the elbow joint in the emergency room (1). If there are any signs of brachial artery injury (absent or weak pulsations of ulnar and radial arteries, excessive swelling at the elbow joint, median nerve palsy), arteriography is the first choice test as Doppler sonography is more user-dependent and might be difficult to Fig.…”

Section: Discussionmentioning

confidence: 99%

“…A dislocation of the elbow joint is the second most common dislocation after the shoulder joint with the incidence of 5-6 cases per 100,000 a year, of which about 90% are posterior or posterolateral dislocations (1)(2)(3). The most common mechanism of the injury is the fall on the hand with an outstretched elbow which creates hyperextension forces in the joint (4).…”

Section: Introductionmentioning

confidence: 99%

Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

Masionis

Bobina

Uvarovas

et al. 2020

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Dislocation of the elbow joint is the second most common dislocation after the shoulder joint. Although this pathology is relatively common, concomitant vascular injuries are rare. We present a case of a patient who sustained a fall on his arm with an outstretched elbow that resulted in a closed simple posterolateral elbow dislocation and delayed thrombosis of the brachial artery followed by two revascularisation surgeries. The physician must always maintain a high index of suspicion for a concomitant vascular injury before and after closed reduction of the elbow joint and have in mind that complete ischemia without any pulsations could be absent because the elbow is surrounded by rich collateral anastomoses. Suspicion should be even stronger in the presence of bony lesions or open injuries. A team of trauma and vascular surgeons has to work hand in hand as surgical treatment with a saphenous graft or direct suture is the first method of choice with the prior requirement of a stable elbow joint.

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“…So wie die einfache Ellenbogenluxation unterschiedlich schwere Instabilitätsausmaße annehmen kann, so reicht die Therapie von der einfachen Ruhigstellung des Gelenks für wenige Tage bis zum komplexen operativen Eingriff. Bislang herrscht in der Fachliteratur keine Einigkeit über die bestmögliche Therapie der Ellenbogenluxation mit ihren unterschiedlich ausgeprägten Instabilitäten [14]. Neben den beschriebenen Indikationen sollten Alter, berufliche und sportliche Anforderungen sowie der Wunsch des Patienten individuell bedacht werden.…”

Section: Säulenmodell Von Ring Und Jupiterunclassified

Ligamentäre Ellenbogeninstabilitäten

Schnetzke¹,

Bergmann²,

Grützner³

2019

Orthopädie und Unfallchirurgie up2date

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The Treatment of Simple Elbow Dislocation in Adults

Abstract: SUMMARYBackground: Simple elbow dislocation is a complex soft-tissue injury that can cause permanent symptoms. Its incidence is 5 to 6 cases per 100 000 persons per year. Its proper treatment is debated; options range from immobilization in a cast to surgical intervention.

Cited by 42 publications

References 40 publications

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

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

Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

Ligamentäre Ellenbogeninstabilitäten

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