Abstract
AbstractAimWe aimed to compare the clinical results after ligamentous elbow dislocation between patients treated nonoperatively (group A) and patients who underwent ligamentous repair (group B).MethodsHospital records were investigated for cases of ligamentous elbow dislocation from January 2015 to December 2018. In total, 30 patients were identified: nine with nonoperative treatment and 21 with surgical ligamentous repair. The range of motion (ROM) including arc of extension/flexion and pronation/supination, valgus instability, and posterolateral rotatory instability were evaluated. The scores of several outcome measures assessing elbow injury were evaluated. Sonographic examination was performed on all patients to evaluate translation under valgus and posterolateral rotatory stress.ResultsOverall, 14 patients with simple elbow dislocation (group An = 5, 46.4 ± 19.3 years, follow-up [FU] 27 ± 12.4 months; group Bn = 9, 57.3 ± 21.0 years, FU 36 ± 11.1 months; 4 female patients in each group) were evaluated. No significant difference was seen in extension/flexion and ext/flex-arc although there was a tendency to limited extension (p = 0.07) in group A. A significantly reduced supination (84 ± 15° vs. 77 ± 21°,p = 0.02) was observed regarding the contralateral side in group B. There was no significant difference in the evaluated scores between the groups. A significantly increased medial angulation during ultrasound evaluation was found in group B compared with the contralateral side.ConclusionThere were no significant differences concerning ROM and functional scores between the nonoperative treatment and ligamentous repair groups. On clinical evaluation, a higher rate of sufficiently healed ligaments was found following surgical repair, although this was not reflected in the ultrasound evaluation.
Highlights
Dislocation of the elbow is the second most common joint dislocation in adults [24]
Side was found in group B, the clinical relevance is questionable
No significant difference was observed between the two groups in terms of range of motion (ROM)
Summary
The most common cause is a fall on the outstretched arm. The elbow is circumferentially stabilized by bony, ligamentous, and muscular structures that can be divided into primary and secondary static and dynamic stabilizers [16]. The ulnohumeral joint with the coronoid process as anterior resistance to dislocation and the medial and lateral collateral ligament complex are termed “primary stabilizers.”. The radiohumeral joint as a static structure and the common extensor and flexor–pronator tendons as dynamic structures are the secondary stabilizers of the elbow joint [17]. While the loading axis is shifted laterally, a valgus force is created. These forces cause the ligament structures to tear, starting with the lateral ulnar collateral ligament, resulting in posterolateral rotational instability. O’Driscoll et al differentiated between three stages, ranging from a ligament tear (stage 1) to a grossly unstable elbow (stage 3c)
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