Treatment Outcomes of Simple Elbow Dislocations: A Systematic Review of 1,081 Cases.

IF 1.7 Q2 SURGERY JBJS Reviews Pub Date : 2024-01-05 eCollection Date: 2024-01-01 DOI:10.2106/JBJS.RVW.23.00135

Charlotte M J M Pott, Huub H de Klerk, Simone Priester-Vink, Denise Eygendaal, Michel P J van den Bekerom

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Abstract

Background: The treatment of simple elbow dislocations (SEDs) has become more functional last decade with a tendency to shorter immobilization of the elbow, whereas simultaneously, surgical stabilization has been promoted by some authors. The primary aim of this study was to systematically review the literature and analyze the outcomes and complications of different treatment options for acute and persistent SEDs, including operative and nonoperative treatments with varying immobilization periods.

Methods: A literature search was performed based on the online medical databases MEDLINE, Embase, and the Cochrane databases. Articles presenting patients with a SED were eligible for inclusion. When an SED persists for >3 weeks, it is categorized as persistent. Various outcome measures were assessed, including the range of motion (ROM), patient-reported outcome measures, and complication rates. To get insight into the severity of complications, all complications were categorized as minor or major. The Methodological Index for Nonrandomized Studies was used to assess the methodological quality of nonrandomized studies. The risk of bias in the randomized studies was assessed with the Cochrane risk-of-bias tool.

Results: A total of 37 articles were included with 1,081 dislocated elbows (1,078 patients). A fair quality of evidence was seen for the nonrandomized studies and a low risk of bias for the randomized study. Nonoperative treatment was administered to 710 elbows, with 244 elbows treated with early mobilization, 239 with 1- to 3-week immobilization, and 163 with ≥3-week immobilization. These groups showed a ROM flexion-extension arc (ROM F/E) of 137, 129, and 131°, respectively. Surgical treatment as open reduction and ligament repair or reconstruction was performed in 228 elbows and showed a ROM F/E of 128°. All persistent SEDs were treated surgically and showed a ROM F/E of 90°.

Conclusion: The early mobilization treatment showed the most consistent satisfactory outcomes in the literature compared with the other treatment options. Nevertheless, there remains ambiguity regarding which patients would benefit more from surgery than nonoperative treatment.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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单纯性肘关节脱位的治疗结果：对 1,081 例病例的系统回顾。

背景：近十年来，单纯性肘关节脱位（SED）的治疗变得更加功能化，倾向于缩短肘关节的固定时间，与此同时，一些学者也提倡手术稳定肘关节。本研究的主要目的是系统回顾文献，分析急性和顽固性 SED 不同治疗方案的结果和并发症，包括不同固定时间的手术和非手术治疗：方法：根据在线医学数据库 MEDLINE、Embase 和 Cochrane 数据库进行文献检索。介绍 SED 患者的文章均符合纳入条件。如果 SED 持续时间超过 3 周，则被归类为持续性 SED。对各种结果指标进行了评估，包括活动范围 (ROM)、患者报告的结果指标和并发症发生率。为了了解并发症的严重程度，所有并发症都被分为轻微和严重并发症。非随机研究方法指数用于评估非随机研究的方法质量。随机研究的偏倚风险采用 Cochrane 偏倚风险工具进行评估：共纳入 37 篇文章，涉及 1,081 例肘关节脱位（1,078 例患者）。非随机研究的证据质量尚可，随机研究的偏倚风险较低。对710个肘部进行了非手术治疗，其中244个肘部接受了早期活动治疗，239个肘部接受了1至3周的固定治疗，163个肘部接受了≥3周的固定治疗。这些组别的屈伸弧度（ROM F/E）分别为137、129和131°。有228只肘关节接受了开放性缩窄和韧带修复或重建的手术治疗，结果显示ROM F/E为128°。所有持续性SED均接受了手术治疗，ROM F/E为90°：结论：与其他治疗方案相比，早期活动治疗在文献中显示出最一致的满意结果。结论：与其他治疗方案相比，早期活动治疗在文献中显示出最一致的满意结果。然而，对于哪些患者从手术治疗中获益比非手术治疗更多，目前仍不明确：证据等级：IV 级。有关证据等级的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.