Traumatic Elbow Dislocations

Abstract

The elbow is the second most common major joint to dislocate after the shoulder in the adult population. Its stability is highly dependent on a complex interaction between bony articulations, capsuloligamentous structures and dynamic muscle restraints. Dislocations are traditionally classified by the presence (complex dislocations) or absence (simple dislocations) of associated fractures and by the direction of the displacement of the forearm relative to the humerus. The general aim of this thesis was to study the optimal treatment for simple and complex elbow dislocations in terms of functional outcome, range of motion, quality of life, adverse events and healthcare consumption with associated costs. Between 1986 and 2008 the mean incidence rate of elbow dislocations was 5.6 per 100,000 person years. The total costs for elbow dislocations were €1.63 million per year, most of which was accounted for by the female population (1.14 million versus €0.49 million by males). We found that patients with simple elbow dislocations recovered faster and returned to work eight days sooner when treated with early mobilization compared to patients that were treated with plaster immobilization. Early mobilization did not lead to recurrent dislocations. Mean total costs (including costs for work absenteeism) per patient were €3,624 in the early mobilization group versus €7,072 in the plaster group. We also demonstrated that the Dutch version of the Oxford Elbow Score is a reliable, valid and responsive instrument for evaluating elbow related quality of life. Even in non-operatively treated patients. Concerning complex elbow dislocations, we found that hin