title: The epidemiology of closed reduction for simple elbow dislocations and the incidence of early subsequent open reduction.
abstract: BACKGROUND
  Simple elbow dislocations are often treated with closed reduction (CR); however, the rate of CR failure and factors that may predict failure have been largely underinvestigated. The objectives of this study were (1) to determine the incidence of elbow dislocations treated by CR in a universal health care system and (2) to identify patient characteristics associated with failed CR, defined as the subsequent need for open reduction.
  
  
  METHODS
  Patients ≥16 years old who underwent elbow CR by a physician between 1994 and 2010 were identified from administrative databases. Concurrent elbow fractures were excluded. The incidence density rate (IDR) of CR per 100,000 eligible person-years among the general population was calculated. Failed CR was defined as subsequent open reduction with or without ligament repair or reconstruction within 90 days. Patient and provider characteristics were modeled in a multivariate logistic regression for failure.
  
  
  RESULTS
  The cohort consisted of 4878 patients (median age, 41 years) who underwent CR (IDR, 2.65 per 100,000 person-years), and 75 (1.5%) underwent subsequent open reduction with or without ligament repair or reconstruction (median time, 15 days). Young men (≤20 years) had the highest IDR (7.45 per 100,000 person-years), twice that of young women (P = .005). Patient characteristics associated with failed CR included older age (P = .001), admission to the hospital (P < .0001), >1 attempted CR (P = .001), and new orthopedic consultation in the 4 weeks after the CR (P = .02).
  
  
  CONCLUSIONS
  Young men are at highest risk for CR for simple elbow dislocations; however, older patients are more likely to require open intervention, as are those with markers of a difficult reduction signifying potentially greater soft tissue damage. A comprehensive understanding of the epidemiology of simple elbow dislocation will aid management decisions.
authors.affiliation: Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital, Toronto, ON, Canada. Electronic address: ian.mayne@mail.utoronto.ca.
authors.forename: Ian P
authors.initials: IP
authors.lastname: Mayne
authors.affiliation: Division of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada; University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wasserstein
authors.affiliation: Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Chetan S
authors.initials: CS
authors.lastname: Modi
authors.affiliation: Division of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada; University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada.
authors.forename: Patrick D G
authors.initials: PD
authors.lastname: Henry
authors.affiliation: Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Nizar
authors.initials: N
authors.lastname: Mahomed
authors.affiliation: Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital, Toronto, ON, Canada; University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Veillette
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D017211:Treatment Failure; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Elbow; elbow dislocation; epidemiology; incidence; trauma