Is an arm sling indicated for elbow fracture dislocation?

Arm Sling for Elbow Fracture Dislocation

Yes, an arm sling is indicated for elbow fracture dislocation as part of the initial management and post-reduction support, though it should be used for early mobilization rather than prolonged immobilization. 1, 2

Initial Management of Elbow Fracture Dislocation

Elbow fracture dislocations are complex injuries involving both bony and soft tissue damage that require careful management to optimize outcomes. The approach depends on the specific pattern of injury:

• Initial stabilization: After reduction of the dislocation, a sling provides appropriate support while allowing controlled early mobilization 1
• Imaging assessment: Radiographs are the first-line imaging modality to assess fracture patterns and guide treatment decisions 3
• Classification: Understanding the pattern of injury (posterolateral, posteromedial, Monteggia type, or anterior trans-olecranon) helps determine the optimal management approach 4, 5

Evidence for Sling Use vs. Rigid Immobilization

Research strongly supports the use of a sling with early mobilization rather than rigid immobilization in plaster:

• A comparative study showed significantly better functional outcomes with sling support and early mobilization compared to plaster immobilization 2
• Patients treated with sling and early mobilization returned to work in half the time (3.2 vs. 6.6 weeks) compared to those with plaster immobilization 2
• Early mobilization with sling support did not result in redislocation or late instability of the elbow 2

Treatment Algorithm Based on Injury Pattern

1. Simple elbow dislocations (no associated fractures):

   • Closed reduction followed by sling support
   • Early controlled mobilization starting within days of injury
   • Progressive range of motion exercises

2. Complex elbow fracture dislocations:

   • Surgical intervention for unstable injuries with significant displacement or angulation 1
   • Post-operative support with arm sling
   • Controlled early mobilization based on stability assessment

3. Terrible triad injuries (posterolateral dislocation with radial head and coronoid fractures):

   • Almost always require surgical intervention 4
   • Post-operative sling support with carefully planned mobilization protocol

Post-Reduction/Post-Surgical Care

• Begin progressive range of motion exercises after the initial period of protection (typically within 1-2 weeks) 1
• Use sling for comfort between exercise sessions
• Directed home exercise programs including active finger motion exercises to prevent stiffness 1

Common Pitfalls to Avoid

1. Prolonged rigid immobilization: This leads to joint stiffness, the most common complication of elbow injuries 1
2. Delayed mobilization: Can result in poor functional outcomes and prolonged recovery time 2
3. Inadequate assessment of stability: Failure to recognize unstable patterns requiring surgical intervention before mobilization
4. Overlooking associated injuries: Complex elbow fracture dislocations often involve multiple columns of stability and soft tissue injuries 6, 5

By using a sling for support while implementing early controlled mobilization, you can optimize functional outcomes and reduce recovery time for patients with elbow fracture dislocations.