Reported outcome measures in complex fracture elbow dislocations: a systematic review

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Rehabilitation Medicine

Background:

• Complex elbow fracture dislocations present management challenges and often lead to poor patient outcomes.
• Standardization of patient-reported outcome measures (PROMs) is lacking, hindering cross-study comparisons in existing literature.
• This systematic review aims to identify injury patterns, outcome measures, and complications in complex elbow fracture dislocation studies to inform future reporting recommendations.

Approach:

• A systematic review was conducted following PRISMA guidelines, searching major databases for studies published between 2010 and 2022.
• Articles reporting on adult patients with complex elbow fracture dislocations (excluding pathologic fractures) were included.
• Data extraction focused on patient demographics, injury patterns, outcome measures, and complications, with bias assessment using the Methodological Index for Non-Randomized Studies criteria.

Key Points:

• Ninety-one studies involving 3664 elbows were analyzed, with 'terrible triad' injuries being the most common (87%).
• Range of motion was frequently reported (96%), while strength assessment was infrequent (12%).
• A wide variety of PROMs were used (14 different scores), with the Mayo Elbow Performance Score (83%) and DASH score (34%) being most common, yet no significant trend in PROM usage was observed over time or by study type.

Conclusions:

• Significant heterogeneity exists in the PROMs reported for complex elbow fracture dislocations.
• While no definitive gold standard PROM is established, the Mayo Elbow Performance Score, DASH score, and visual analog scale for pain are recommended for future studies.
• Adopting these standardized measures will improve the comparability and reliability of research findings in this field.