Purpose
While conservative management is commonly promoted for simple elbow dislocations, the importance of primary surgical treatment in these injuries is still undetermined. The objective of this study was to compare patient rated outcome measurements (PROMs) and joint stability via ultrasound in patients following conservative or surgical treatment after simple elbow dislocation.
Methods
Patients with a minimum follow-up of 24 months after conservative or surgical treatment following simple elbow dislocation were included. To evaluate patients’ individual postoperative outcome and satisfaction, the Elbow-Self-Assessment-Score (ESAS) was used, and validated scores such as the Mayo elbow performance score (MEPS) and Quick Disability of Arm and Shoulder Score (Quick DASH) were assessed. For objective assessment of joint instability, a standardized clinical and dynamic ultrasound evaluation of the affected and contralateral elbow were performed.
Results
44 patients (26 women, 18 men) with an average age of 41.5 ± 15.3 years were clinically and sonographically assessed. The mean follow-up period was 65.5 ± 30.4 months (range 26 - 123). 21 patients were treated conservatively (CT group) in accordance with a standardized protocol and 23 patients (ST group) received surgical treatment. No statistical difference was found between the conservative group and the surgical group concerning ROM, the ESAS (CT group: 99.4 ± 1.5 points; ST group: 99.8 ± 0.3 points), MEPS (CT group: 97.3 ± 6.8 points; ST group: 98.7 ± 3.3 points) and Quick DASH (CT group: 7.8 ± 10.4 points; ST group: 6.3 ± 7.9 points) (p>0,05). Two patients (9.5%) reported severe subjective instability of the treated elbow (both CT group). No statistically significant difference was found in sonographic measurements comparing the two groups and the two groups to their respective unaffected side (p>0.05).
Conclusion
Patients with conservatively, as well as surgically treated simple elbow dislocations can achieve high patient satisfaction and good to excellent clinical results. Even though ultrasound evaluation showed no significant differences in joint gapping between groups, nearly 10% of the conservative treated patients complained about severe subjective instability. Thus, especially for high demanding patients, individual conditions should be considered and discussed regarding primary surgical approach.