title: The frequency and risk factors for subsequent surgery after a simple elbow dislocation.
abstract: BACKGROUND
  Simple elbow dislocations treated by closed reduction are thought to result in a satisfactory return of function in most patients. Little, however, is known about how many patients ultimately proceed to subsequent surgical treatment due to the low patient numbers and significant loss to follow-up in the current literature. The purpose of this study was to establish the rate of and risk factors for subsequent surgical treatment after closed reduction of a simple elbow dislocation at a population level.
  
  
  METHODS
  All patients aged 16 years or older who underwent closed reduction of a simple elbow dislocation between 1994 and 2010 were identified using a population database. Subsequent procedures performed for joint contractures, instability or arthritis were recorded. Outcomes were modelled as a function of age, sex, income quintile, co-morbidity, urban/rural status, physician speciality performing the initial reduction and whether orthopaedic consultation and/or post-reduction radiograph was performed within 28 days of the injury, in a time-to-event analysis.
  
  
  RESULTS
  We identified 4878 elbow dislocations with a minimum 2-year follow-up: stabilisation surgery was performed in 112 (2.3%) at a median time of 1 month, contracture release in 59 (1.2%) at median 9 months and arthroplasty in seven (0.1%) at median 25 months. Admission to hospital for the initial reduction was associated with an increased risk of undergoing stabilisation (hazard ratio (HR), 2.50; 95% confidence interval (CI), 1.67-3.74) and contracture release (HR, 1.93; CI, 1.08-3.44). Multiple reduction attempts increased the risk of requiring contracture release (HR, 3.71; CI, 1.22-11.29). Survival analysis demonstrated that all subsequent procedures had taken place by 4-5 years.
  
  
  CONCLUSIONS
  Few patients with simple elbow dislocations develop complications requiring surgery, but those that do most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury. Contrary to current thinking, surgery for instability is performed more often than joint contracture release, albeit with slightly different time patterns.
authors: Division of Orthopaedic Surgery, Arthritis Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada; University of Toronto Sports Medicine Program, Women's College Hospital, Toronto, ON, Canada. Electronic address: Chetan.modi@uhcw.nhs.uk.
authors: Chetan S
authors: CS
authors: Modi
authors: Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto Sports Medicine Program, Women's College Hospital, Toronto, ON, Canada.
authors: David
authors: D
authors: Wasserstein
authors: Division of Orthopaedic Surgery, Arthritis Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada.
authors: Ian P
authors: IP
authors: Mayne
authors: Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors: Patrick D G
authors: PD
authors: Henry
authors: Division of Orthopaedic Surgery, Arthritis Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors: Nizar
authors: N
authors: Mahomed
authors: Division of Orthopaedic Surgery, Arthritis Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada; University of Toronto Sports Medicine Program, Women's College Hospital, Toronto, ON, Canada.
authors: Christian J H
authors: CJ
authors: Veillette
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003286:Contracture / Q000453:epidemiology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D007593:Joint Instability / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D000092464:Elbow Injuries
keywords: Contracture; Dislocation; Elbow; Joint instability; Population characteristics; Treatment outcome