The frequency and risk factors for subsequent surgery after a simple elbow dislocation

Area of Science:

• Orthopedic Surgery
• Traumatology
• Musculoskeletal Research

Background:

• Simple elbow dislocations treated non-surgically typically restore function.
• Limited data exists on the rate and risk factors for subsequent surgical intervention following closed reduction of elbow dislocations.

Purpose of the Study:

• To determine the incidence of and identify risk factors for subsequent surgical treatment after closed reduction of simple elbow dislocations at a population level.

Main Methods:

• A population-based study analyzed 4878 patients (≥16 years) undergoing closed reduction for simple elbow dislocations (1994-2010).
• Subsequent procedures (stabilization, contracture release, arthroplasty) were recorded.
• Time-to-event analysis modeled outcomes based on patient demographics, comorbidities, and initial treatment details.

Main Results:

• 2.3% (n=112) had stabilization surgery, 1.2% (n=59) contracture release, and 0.1% (n=7) arthroplasty.
• Hospital admission for initial reduction increased risk for stabilization (HR 2.50) and contracture release (HR 1.93).
• Multiple reduction attempts elevated contracture release risk (HR 3.71); all subsequent surgeries occurred within 4-5 years.

Conclusions:

• While most simple elbow dislocations resolve without surgery, a small percentage require interventions like soft-tissue stabilization or contracture release.
• Surgery for instability is more frequent than for joint contracture release, contrary to prior assumptions.
• Subsequent surgical procedures are typically performed within four years post-injury.