Patient-reported outcomes after simple dislocation of the elbow

Abstract

Background: The current study was designed to investigate the epidemiology and long-term clinical and patient-reported outcomes following simple dislocation of the elbow in adults.

Methods: We identified all adult patients treated at our trauma center for a simple dislocation of the elbow during a ten-year period. One hundred and forty patients were eligible for review, and 110 (79%) were reviewed at a mean of eighty-eight months (range, sixteen to 171 months) after the injury. This review included clinical examination, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Oxford elbow questionnaire, and a patient satisfaction questionnaire.

Results: Patients reported long-term residual deficits in the range of elbow motion. The mean DASH score was 6.7 points (95% confidence interval, 4 to 9 points). The mean Oxford elbow score was 90.3 points (95% confidence interval, 87.8 to 92.9 points). The mean satisfaction score was 85.6 points (95% confidence interval, 82.2 to 89 points). Sixty-two patients (56%) reported residual subjective stiffness of the elbow. Nine patients (8%) reported subjective instability, and sixty-eight (62%) reported residual pain. The satisfaction and DASH scores showed good correlation with absolute range of motion in the injured elbow, as did the overall Oxford elbow score and the pain and function components of that score. Multivariate analysis demonstrated that loss of elbow flexion (p = 0.001) and female sex (p = 0.002) were both independent predictors of a poorer DASH score. Reduced elbow flexion also predicted a poorer score on the function component of the Oxford elbow score (p = 0.02). A reduced flexion-extension arc of motion predicted a poorer overall Oxford elbow score (p = 0.02), a poorer score on the pain component of the Oxford elbow score (p = 0.02), and poorer overall satisfaction (p = 0.005). Female sex predicted a poorer score on the psychosocial component of the Oxford elbow score (p < 0.05).

Conclusions: Although patients generally report a favorable long-term functional outcome after simple dislocation of the elbow, these injuries are not entirely benign. The rate of residual pain and elbow stiffness is high. Functional instability is less common and does not often limit activities.