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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
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van der Horst AS, Stephens AR, Wei G, Presson AP, Tashjian RZ, Kazmers NH. Prognostic Factors Affecting Long-Term Outcomes After Elbow Dislocation: A Longitudinal Cohort Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:260-265. [PMID: 34632352 PMCID: PMC8496876 DOI: 10.1016/j.jhsg.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose To describe patient-reported outcomes following simple elbow dislocation and to identify the baseline factors that predict outcomes. Methods Adult patients treated with a closed reduction for a simple elbow dislocation with or without minor fracture (coronoid avulsion, radial head fracture, or epicondyle avulsion) from 2000 to 2018 completed outcome instruments including Disabilities of the Arm, Shoulder and Hand (QuickDASH) via Research Electronic Data Capture. Descriptive statistics were calculated. Univariate followed by multivariate Tobit regression models were used to determine factors associated with clinical outcomes on QuickDASH. Social deprivation was measured using the Area Deprivation Index. Patients with additional upper-extremity injuries or associated major fractures (Monteggia or terrible triad injuries, distal humerus fractures, etc) were excluded. Results At a mean follow-up of 67.5 months, 95% (38/40) of patients reported satisfaction with treatment, and clinical outcomes were good (QuickDASH 9.0 ± 14.8). Univariate analysis showed that higher Area Deprivation Index, older age, female sex, high-energy mechanism of injury, and worker’s compensation (WC) or Medicare insurance status (vs commercial) was associated with significantly worse QuickDASH scores at follow-up. Early therapy, dominant elbow involvement, presence of minor fractures (minimally displaced radial head, coronoid tip, or epicondylar avulsion fractures), race, and treating service did not influence outcomes in univariate analyses. Multivariate analysis demonstrated a significant association between increased social deprivation, WC insurance, and Medicare insurance and worse QuickDASH scores while controlling for new upper-extremity injury, age, sex, and mechanism of injury. Conclusions Outcomes and treatment satisfaction following simple elbow dislocation are generally good but are significantly worse for the patients with greater levels of social deprivation and WC or Medicare insurance. Although surgeons should be aware of the possibility that specific subsets of patients may benefit from early therapy, this factor did not appear to influence long-term outcomes in this small cohort. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Anna S van der Horst
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.,OrthoIndy Trauma, Ascension St. Vincent Hospital, Indianapolis, IN
| | | | - Guo Wei
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Abstract
Pediatric orthopedic injuries are a common reason for presentation to the emergency department. This article sequentially discusses 2 important upper extremity injuries that require prompt management in the emergency department. Radial head subluxations are discussed with a focus on current evidence for imaging, reduction techniques, and follow-up. Elbow dislocations, although less common than radial head subluxations, are also addressed, highlighting imaging, reduction, immobilization, and follow-up recommendations.
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Díaz Suárez R, Luengo Alonso G, Porras Moreno MÁ, Jiménez Díaz V, García Lamas L, Cecilia López N. Unusual case of complex fracture dislocation of the elbow. Strategies Trauma Limb Reconstr 2018:10.1007/s11751-018-0322-1. [PMID: 30421352 DOI: 10.1007/s11751-018-0322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rebeca Díaz Suárez
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain.
| | - Gonzalo Luengo Alonso
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain
| | - Miguel Ángel Porras Moreno
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain
- Hospital Universitario 12 de Octubre, Unidad Mano y Codo, Madrid, Spain
| | - Verónica Jiménez Díaz
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain
- Hospital Universitario 12 de Octubre, Unidad Mano y Codo, Madrid, Spain
- Departamento de Cirugía, Universidad Complutense, Madrid, Spain
| | - Lorena García Lamas
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain
- Hospital Universitario 12 de Octubre, Unidad Mano y Codo, Madrid, Spain
| | - Navidad Cecilia López
- Hospital Universitario 12 de Octubre, Servicio Cirugia Ortopedica Y Traumatologia, Planta 7 Residencia General Av Cordoba SN Km 5400, Madrid, Spain
- Hospital Universitario 12 de Octubre, Unidad Mano y Codo, Madrid, Spain
- Departamento de Cirugía, Universidad Complutense, Madrid, Spain
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5
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Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med 2018; 54:849-854. [DOI: 10.1016/j.jemermed.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 01/13/2023]
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Abstract
Elbow dislocations are more common in athletes than in the general population. Simple elbow dislocations should be managed with early range of motion and early return to sport, even with high-level contact athletes. Patients with instability on examination or with complex elbow dislocations may require surgical intervention. Overall, the outcomes after simple elbow dislocations are excellent and athletes should be able to return to play without significant limitations.
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Affiliation(s)
- Mark S Morris
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive TC2912, Ann Arbor, MI 48109-5328, USA
| | - Kagan Ozer
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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Iordens GIT, Van Lieshout EMM, Schep NWL, De Haan J, Tuinebreijer WE, Eygendaal D, Van Beeck E, Patka P, Verhofstad MHJ, Den Hartog D. Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial. Br J Sports Med 2015; 51:531-538. [PMID: 26175020 DOI: 10.1136/bjsports-2015-094704] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery. METHODS From August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year. RESULTS Quick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred. CONCLUSIONS Early active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year. TRIAL REGISTRATION NUMBER NTR 2025.
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Affiliation(s)
- Gijs I T Iordens
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Niels W L Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeroen De Haan
- Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Ed Van Beeck
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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The role of simple elbow dislocations in cubitus valgus development in children. INTERNATIONAL ORTHOPAEDICS 2013; 38:797-802. [PMID: 24337926 DOI: 10.1007/s00264-013-2199-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/11/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. METHODS Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). RESULTS All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137° (range, 130-145°) and average extension was 8.6° (range 0-20°) with full supination and pronation in traumatic elbow. Four patients (36.4%) had an average increase (cubitus valgus) of 14.5° (10-20°) in carrying angle compared to the other elbow. CONCLUSIONS While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development.
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Alolabi B, Gray A, Ferreira LM, Johnson JA, Athwal GS, King GJW. Rehabilitation of the medial- and lateral collateral ligament-deficient elbow: an in vitro biomechanical study. J Hand Ther 2013; 25:363-72; quiz 373. [PMID: 22959533 DOI: 10.1016/j.jht.2012.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 05/23/2012] [Accepted: 06/03/2012] [Indexed: 02/03/2023]
Abstract
DESIGN In vitro biomechanical research using an elbow motion simulator. INTRODUCTION The optimal rehabilitation of elbow dislocations with medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries has not been defined. PURPOSE To determine a safe rehabilitation protocol for elbow dislocations with MCL and LCL injuries. METHODS Eight cadaveric elbows underwent simulated active and passive motions with the arm in multiple orientations. Varus-valgus angulation and internal-external rotation of the ulna relative to the humerus were quantified for the intact joint and with injured MCL and LCL. RESULTS Active motion with injured MCL and LCL in the horizontal and vertical orientations resulted in kinematics similar to the intact elbow, whereas passive motion resulted in significant kinematic alterations. Marked elbow instability was noted in the varus and valgus orientations using both active and passive motion. CONCLUSIONS Elbows with MCL and LCL injuries should be rehabilitated using active motion in the horizontal or vertical orientations. LEVEL OF EVIDENCE Basic science research.
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Affiliation(s)
- Bashar Alolabi
- Hand and Upper Limb Center, St. Joseph's Health Centre, London, Ontario, Canada.
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Kiene J, Wäldchen J, Paech A, Jürgens C, Schulz A. Midterm Results of 58 Fractures of the Coronoid Process of the Ulna and their Concomitant Injuries. Open Orthop J 2013; 7:86-93. [PMID: 23667407 PMCID: PMC3648775 DOI: 10.2174/1874325001307010086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In general, fractures of the coronoid process are rare and usually occur in combination with additional elbow joint injuries. The treatment of these injuries aims to regain a stable as well as a flexible and loadable joint. Although there is currently little evidence, therapy recommendations remain controversial. Therefore, the aim of this study was to prognostically determine relevant factors for therapy recommendation by analysing a representative patient population of two trans-regional trauma centres. MATERIAL AND METHODS Seventy-seven patients with a fracture of the coronoid process were treated within an 8-year period (2001 to 2009). After an average of 48 months (SD 31), treatment outcome of 58 patients (75%) was acquired. The results were statistically analysed. RESULTS The average age of the patient was 51.8 years (SD 13.6); 36 were male and 34 had a fracture on the right arm. Applying the fracture types of the coronoid process in accordance with Regan/Morrey, the result was: Type I (19), II (17) and III (22). Further injuries were also detected: 40 radial head fractures, 17 proximal ulnar fractures and 2 fractures of the olecranon. A luxation was detected in 44 of the 58 patients (76%). The patients' average MEPS (Mayo Elbow Performance Score) was 80.6 points (SD 18), with significant differences between the various therapy strategies. Fifteen% of the coronoid process fractures were reconstructable to a limited extent only by means of osteosynthesis. In 33% of the patients, instabilities remained. The average extension/flexion came to 107° (SD 28), and pronation and supination 153° (SD 38). CONCLUSION At present, a surgical therapy of ligamentary injuries cannot be statistically justified. A stable osseous reconstruction appears to make more sense. The strongest negative prognostic parameters in our patient population were: therapy with an external fixator, immobilisation for more than 21 days, the occurrence of complications and unstable osteosyntheses on the coronoid process.
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Affiliation(s)
- J Kiene
- Clinic for Surgery of the Skeletal and Locomotor System, Department of Accident Surgery, University Medical Centre - Lübeck Site, Germany
| | - J Wäldchen
- Clinic for Surgery of the Skeletal and Locomotor System, Department of Accident Surgery, University Medical Centre - Lübeck Site, Germany
| | - A Paech
- Clinic for Surgery of the Skeletal and Locomotor System, Department of Accident Surgery, University Medical Centre - Lübeck Site, Germany
| | - Ch Jürgens
- Accident Hospital of the Occupational Insurance Association Hamburg, Clinic for Accident and Reconstructive Surgery, Germany
| | - A.P Schulz
- Accident Hospital of the Occupational Insurance Association Hamburg, Clinic for Accident and Reconstructive Surgery, Germany
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A hinged external fixator for complex elbow dislocations: a multicenter prospective cohort study. BMC Musculoskelet Disord 2011; 12:130. [PMID: 21658252 PMCID: PMC3121661 DOI: 10.1186/1471-2474-12-130] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/09/2011] [Indexed: 11/20/2022] Open
Abstract
Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator. Trial Registration The trial is registered at the Netherlands Trial Register (NTR1996).
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