Interventions for treating acute elbow dislocations in adults

• Published in: Cochrane database of systematic reviews 2012-04, Vol.2012 (4), p.CD007908-CD007908
• Main Authors: Taylor, Fraser, Sims, Martyn, Theis, Jean-Claude, Herbison, G Peter
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Casts, Surgical; Early Ambulation; Elbow Joint - injuries; Elbow Joint - surgery; Humans; Immobilization - methods; Joint Dislocations - surgery; Joint Dislocations - therapy; Ligaments, Articular - injuries; Ligaments, Articular - surgery; Manipulation, Orthopedic - methods; Medicine General & Introductory Medical Sciences; Range of Motion, Articular; Treatment Outcome
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD007908.pub2

Dislocation of the elbow joint is a relatively uncommon injury. To assess the effects of various forms of treatment for acute simple elbow dislocations in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011 Issue 1), MEDLINE (1948 to March Week 5 2011), EMBASE (1980 to 2011 Week 14), PEDro (April 2011), CINAHL (April 2011), various trial registers, various conference proceedings and bibliographies of relevant articles. Randomised or quasi-randomised controlled trials of conservative and surgical treatment of dislocations of the elbow in adults. Excluded were trials involving dislocations with associated fractures, except for avulsion fractures. Data extraction and assessment of risk of bias were independently performed by two review authors. There was no pooling of data. Two small randomised controlled trials, involving a total of 80 participants with simple elbow dislocations, were included. Both trials were methodologically flawed and potentially biased.One trial, involving 50 participants, compared early mobilisation at three days post reduction versus cast immobilisation. At one year follow-up, the recovery of range of motion appeared better in the early mobilisation group (e.g. participants with incomplete recovery of extension: 1/24 versus 5/26; risk ratio 0.22, 95% confidence interval 0.03 to 1.72). However, the results were not statistically significant. There were no reports of instability or recurrence. One person in each group had residual pain at one year.The other trial, involving 30 participants, compared surgical repair of the torn ligaments versus conservative treatment (cast immobilisation for two weeks). At final follow-up (mean 27.5 months), there were no statistically significant differences between the two groups in the numbers of patients who considered their injured elbow to be inferior to their non-injured elbow (10/14 versus 7/14; RR 1.43, 95% CI 0.77 to 2.66) or in other patient complaints about their elbow such as weakness, pain or weather-related discomfort. There were no reports of instability or recurrence. There were no statistically significant differences between the two groups in range of motion of the elbow (extension, flexion, pronation, and supination) or grip strength at follow-up. No participants had neurological disturbances of the hand but two surgical group participants had recurrent di