From the Guidelines
The treatment for an elbow dislocation is closed reduction for patients with mild instability, while those with gross instability require surgical fixation.
Treatment Approach
- For patients with mild instability, defined as less than 10 degrees of joint widening, conservative measures are recommended, which include closed reduction and immobilization.
- Patients with moderate instability, defined as more than 10 degrees of joint widening, may also be treated with conservative measures, but their outcomes may be worse compared to those with mild instability, as shown by lower Mayo Elbow Performance Scores (MEPS) 1.
- In cases of gross instability, where frank redislocation occurs at stress testing, surgical fixation is necessary to stabilize the joint and prevent further complications.
Diagnostic Imaging
- Diagnostic imaging, particularly fluoroscopy and MRI, plays a crucial role in assessing the degree of joint instability and guiding treatment decisions 1.
- Comparison with the contralateral elbow can be helpful in identifying asymmetry and assessing joint stability.
Outcome
- Patients with mild instability tend to have better outcomes, with higher MEPS scores, compared to those with moderate or gross instability 1.
From the Research
Treatment Options for Elbow Dislocation
The treatment for elbow dislocation can be categorized into two main approaches: conservative and surgical.
- Conservative therapy is the dominant approach, with a success rate of 84% 2.
- Surgical treatment has a success rate of 80% 2.
Comparison of Treatment Outcomes
Studies have compared the outcomes of conservative and surgical treatments for elbow dislocation.
- Early functional follow-up care seems to be superior to immobilizing therapy with a duration of more than 2 weeks, regardless of the primary therapy chosen 2.
- A systematic review found that early mobilization after conservative treatment strategies showed improved range of motion (ROM) compared to immobilization, as well as excellent clinical outcome scores 3.
- Surgical approaches have shown similar results compared to conservative treatment, leading to improved ROM and Mayo Elbow Performance Score (MEPS) 3.
Specific Treatment Approaches
Different studies have recommended the following treatment approaches:
- Closed reduction and nonsurgical management for simple dislocations 4.
- Open reduction and internal fixation of coronoid and olecranon fractures, repair or replacement of radial head fractures, and lateral collateral ligament repair for complex instability 4.
- Ligament reconstruction for chronic recurrent lateral and medial collateral ligament insufficiencies 4.
- Early mobilization and early functional training of the elbow for conservative treatment 3.
Considerations for Treatment
When deciding on a treatment approach, the following factors should be considered:
- The presence of associated fractures or ligamentous injuries 5, 4.
- The severity of the dislocation and the presence of red flags for persistent instability 3.
- The potential for late complications, such as posttraumatic stiffness, posterolateral joint instability, ectopic ossification, and occult distal radioulnar joint disruption 6.