title: Unstable simple elbow dislocations: medium-term results after non-surgical and surgical treatment.
abstract: OBJECTIVE
  Determination of the appropriate treatment of unstable simple elbow dislocations is difficult and a topic of ongoing discussion. The aim of this study was to analyse the outcome and complications after surgery and conservative treatment, with special focus on post-traumatic joint laxity.
  
  
  METHODS
  In this retrospective study, 118 consecutive patients with simple elbow dislocations underwent stability testing by fluoroscopy after joint reduction and were assigned to groups 1 (slight), 2 (moderate) or 3 (gross) depending on post-traumatic joint laxity. All patients of group 1 underwent conservative treatment, and of group 3 primary ligament repair. In patients with moderate elbow laxity, the treatment was decided individually. All patients underwent a similar functional rehabilitation programme during treatment. Clinical outcome was determined after an average of 3.4 ± 1.5 years using the Mayo Elbow Performance Score (MEPS), and treatment-associated complications and revisions were recorded.
  
  
  RESULTS
  Forty-nine patients (41.5 %) were assigned to group 1, 41 patients (34.7 %) to group 2 and 28 patients (23.7 %) to group 3. In group 2, 22 patients underwent ligament repair, while 19 patients were treated conservatively. On average, an excellent MEPS was achieved in group 1 after conservative treatment (MEPS 95.8 ± 9.0), similar to results after ligament repair of grossly unstable elbows in group 3 (91.6 ± 11.7). Interestingly, in group 2 conservative treatment was associated with a slightly lower MEPS (90.0 vs. 95.7), and significantly fewer patients achieved an excellent MEPS (81.8 vs. 52.6 %, p = 0.045). Similarly, conservative treatment in group 2 was associated with a fivefold to sixfold risk of complications (p = 0.032) and revision surgery (p = 0.023).
  
  
  CONCLUSIONS
  This study supports the notion that patients with slight elbow laxity can be treated non-operatively, while primary surgical treatment should be performed in patients with moderate and gross laxity to avoid post-traumatic sequelae and decrease revision rates.
  
  
  METHODS
  Retrospective Cohort Study, Level III.
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schnetzke
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Sara
authors.initials: S
authors.lastname: Aytac
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Keil
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Deuss
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Studier-Fischer
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Paul-Alfred
authors.initials: PA
authors.lastname: Grützner
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen on the Rhine, Germany. guehring@uni-heidelberg.de.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Guehring
mesh_terms: D000328:Adult; D004550:Elbow; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery* / Q000628:therapy*; D007593:Joint Instability / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000092464:Elbow Injuries
keywords: Elbow laxity; Fluoroscopy; Mayo Elbow Performance Score; Simple elbow dislocation; Stability testing; Unstable elbow dislocation