The treatment of simple elbow dislocation in adults

Abstract

Background: 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.

Methods: We systematically reviewed the literature on the treatment of simple elbow dislocation and performed a meta-analysis, primarily on the basis of clinical scores and secondarily with respect to pain, range of motion, and return to work.

Results: A randomized controlled trial (RCT) showed that clinical results at short-term follow-up were superior for early functional treatment compared to immobilization in a cast. Brief immobilization, however, reduced pain initially, and the long-term results of early mobilization and immobilization in a cast were the same. Our meta-analysis showed that early mobilization enables patients to return to work earlier (difference of mean values -2.91, 95% confidence interval [CI] -3.18 to -2.64), and that the extent of soft-tissue injury is correlated with the clinical outcome (inverse relationship; difference of mean values -12.07, 95% CI -23.88 to -0.26). Surgical and conservative treatment were compared in a single RCT, which revealed no significant difference in outcomes. A meta-analysis of two retrospective comparative studies showed no advantage of immediate ligament repair over delayed surgery.

Conclusion: Early functional treatment is the evidence-based therapeutic standard for simple elbow dislocation. The past few years have seen further developments in surgery for simple elbow dislocation. Further study is needed to determine whether surgery for elbow dislocation with high-grade instability can prevent persistent pain, limitation of motion, and chronic instability.

Figure 1

Ligaments of the elbow a) Lateral view. The lateral collateral ligament is divided into the lateral ulnar collateral ligament (LUCL, stabilizer against posterolateral translation) and the radial collateral ligament (RCL, stabilizer against varus stress). Both portions insert on the annular ligament (AL). b) Medial view. The medial collateral ligament is divided into an anterior (AMCL) and a posterior (PMCL) bundle. The AMCL is an important stabilizer against valgus stress and inserts on the anteromedial facet of the coronoid process (^*). The PMCL has a fan-shaped insertion on the olecranon (OL). There is also a transverse ligament (TL). c) Sagittal MRI section in joint instability. The longitudinal axis of the radial head (RH) (red line) is projected dorsally to the center of rotation (red dot) of the distal humerus. The yellow double-headed arrow shows the extent of posterolateral subluxation of the radial head. d) Axial section at the level of the coronoid tip. The ulnohumeral joint is decentered with radially separated joint space (red double-headed arrow). AL, annular ligament; OL, olecranon; RH, radial head; HT, humeral trochlea; CAP, capitulum; ME, medial epicondyle; LE, lateral epicondyle

Figure 2

Flow diagram of literature search and analysis