Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #88, 4:16 pm OTA-2011
Simple Dislocation of the Elbow Is Associated With Good Long-Term Patient-Reported Outcomes but Persisting Pain and Stiffness are Common
Raymond E. Anakwe, MD; Scott D. Middleton, MD; Paul J. Jenkins, MD; Margaret M. McQueen, MD; Charles M. Court-Brown, MD;
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Purpose: This study describes the epidemiology, long-term clinical outcomes, and patient-reported outcomes following simple dislocation of the elbow.
Methods: We identified all adult patients treated at our trauma center for a simple dislocation of the elbow over 10 years. 140 patients were identified and 110 (79%) patients were reviewed at a mean of 88 months (95% confidence interval [CI], 80-96) after injury. This included clinical examination, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, an Oxford Elbow questionnaire, and a patient satisfaction questionnaire.
Results: Patients reported long-term residual deficits in range of movement. The mean DASH score was 6.5 (95% CI 4 to 9). The mean Oxford Elbow score was 90.6 (95% CI, 87.9-93.3). The mean satisfaction score was 85.6 (95% CI, 82.2-89). 62 patients (56%) reported persistent subjective stiffness of the elbow. Nine (8%) reported subjective instability and 68 (62%) complained of continued pain. The satisfaction, DASH, and Oxford Elbow scores (including the pain and function component scores) all showed good correlation with absolute range of movement in the injured elbow. After multivariate analysis, loss of elbow flexion (P = 0.001) and female gender (P = 0.002) were both independent predictors of poorer DASH scores. Reduced elbow flexion also predicted poorer scores in the function component of the Oxford Elbow score (P = 0.02). A reduced flexion-extension arc of movement predicted poorer scores for the overall Oxford Elbow score (P = 0.02),the pain component of the Oxford Elbow score (P = 0.02), and overall satisfaction (P = 0.005). Female gender predicted a poorer psychosocial component of the Oxford Elbow score (P <0.05).
Conclusion: Patients report good long-term functional outcomes after simple dislocations of the elbow; however, these are not entirely benign injuries. There is a high rate of residual pain and stiffness. Functional instability is less common and does not often limit activities.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.