Interventions for treating acute elbow dislocations in adults

Elbow dislocation is where the joint surfaces of the elbow become completely separated from each other. It is a relatively uncommon injury. After the bones of the elbow joint are put back into place, under sedation and/or anaesthesia, the arm is usually immobilised in a cast for a week or more. Removal of the cast is often followed by physical therapy aimed at restoring elbow mobility. Surgery is usually reserved for the more severe dislocations, which are generally associated with a fracture (broken bone).

This review includes two trials, involving a total of 80 adults with simple elbow dislocations that had been put back into place (reduced). Both trials were at risk of bias, which means that their results may not be reliable.

One trial compared early mobilisation of the elbow with immobilisation for three weeks in a plaster cast. This trial found no firm evidence of differences between the two interventions in the recovery of elbow range of motion or pain at one year. None of the trial participants had an unstable elbow or had suffered another dislocation.

The other trial compared surgical repair of the torn ligaments versus conservative treatment (cast immobilisation for two weeks). It found no significant difference between the two groups in the numbers of patients who considered their injured elbow to be inferior to their non-injured elbow or in other patient complaints about their elbow such as weakness, pain or weather-related discomfort. There were also no differences between the groups in the range of motion of the elbow or grip strength at follow-up of around two years. There were two people with surgery-related complications. None of the trial participants had an unstable elbow or had suffered another dislocation.

Overall, the review concluded that there was not enough evidence from randomised controlled trials to show which methods of treatment are better for these injuries.

Authors' conclusions: 

There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for simple dislocations of the elbow in adults. Although weak and inconclusive, the available evidence from a trial comparing surgery versus conservative treatment does not suggest that the surgical repair of elbow ligaments for simple elbow dislocation improves long-term function. Future research should focus on questions relating to non-surgical treatment, such as the duration of immobilisation.

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Background: 

Dislocation of the elbow joint is a relatively uncommon injury.

Objectives: 

To assess the effects of various forms of treatment for acute simple elbow dislocations in adults.

Search strategy: 

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.

Selection criteria: 

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 collection and analysis: 

Data extraction and assessment of risk of bias were independently performed by two review authors. There was no pooling of data.

Main results: 

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 dislocation of the ulnar nerve (no other details provided). One person in each group had radiologically detected myositis ossificans (bone formation within muscles following injury).

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