Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study

Abstract

Introduction: Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11-28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences.

Material and methods: A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups.

Results: Among the 44 analyzed patients, the mean age was 48 years, and the mean follow-up time was 29 months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures.

Conclusion: This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions.

Keywords: Complex dislocations; Complex elbow dislocations; Coronoid fractures; Elbow dislocations; Elbow ligament lesions; Radial head fractures.

Fig. 1

A series of images depicting a patient treated for the terrible triad injury. Images A and B display sagittal and coronal CT scans, respectively, showing a fracture of the coronoid process. Image C presents a sagittal CT scan revealing a fracture of the capitellum. Although the elbow dislocation is part of the terrible triad injury, it is not dislocated in these images but rather stabilized in a cast. Images D and E are postoperative anteroposterior (AP) and lateral radiographs. Note the use of an HCS screw for fixation at the radial capitellum, with heterotopic calcification of the adjacent soft tissues (indicated by the white arrow)

Fig. 2

Images A and B display the 3D reconstruction of a complex elbow dislocation with fracture of the olecranon and epitrochlea. Images C and D show postoperative anteroposterior (AP) and lateral X-rays, where the olecranon plate and a screw with a washer for epitrochlear fixation are visible