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Unstable simple elbow dislocations: medium-term results after non-surgical and surgical treatment

  • Elbow
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



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.


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.


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).


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.

Level of evidence

Retrospective Cohort Study, Level III.

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  1. Anakwe RE, Middleton SD, Jenkins PJ, McQueen MM, Court-Brown CM (2011) Patient-reported outcomes after simple dislocation of the elbow. J Bone Joint Surg Am 93(13):1220–1226

    Article  PubMed  Google Scholar 

  2. Coonrad RW, Roush TF, Major NM, Basamania CJ (2005) The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 14(3):312–317

    Article  PubMed  Google Scholar 

  3. de Haan J, den Hartog D, Tuinebreijer WE, Iordens GI, Breederveld RS, Bronkhorst MW, Bruijninckx MM, De Vries MR, Dwars BJ, Eygendaal D, Haverlag R, Meylaerts SA, Mulder JW, Ponsen KJ, Roerdink WH, Roukema GR, Schipper IB, Schouten MA, Sintenie JB, Sivro S, Van den Brand JG, Van der Meulen HG, Van Thiel TP, Van Vugt AB, Verleisdonk EJ, Vroemen JP, Waleboer M, Willems WJ, Polinder S, Patka P, van Lieshout EM, Schep NW (2010) Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial. BMC Musculoskelet Disord 11:263

    Article  PubMed  PubMed Central  Google Scholar 

  4. de Haan J, Schep N, Tuinebreijer W, den Hartog D (2010) Complex and unstable simple elbow dislocations: a review and quantitative analysis of individual patient data. Open Orthop J 4:80–86

    PubMed  PubMed Central  Google Scholar 

  5. de Haan J, Schep NW, Tuinebreijer WE, Patka P, den Hartog D (2010) Simple elbow dislocations: a systematic review of the literature. Arch Orthop Trauma Surg 130(2):241–249

    Article  PubMed  Google Scholar 

  6. Dehlinger FI, Ries C, Hollinger B (2014) LUCL reconstruction using a triceps tendon graft to treat posterolateral rotatory instability of the elbow. Oper Orthop Traumatol 26(4):414-427, 429

  7. Duckworth AD, Ring D, Kulijdian A, McKee MD (2008) Unstable elbow dislocations. J Shoulder Elbow Surg 17(2):281–286

    Article  PubMed  Google Scholar 

  8. Englert C, Zellner J, Koller M, Nerlich M, Lenich A (2013) Elbow dislocations: a review ranging from soft tissue injuries to complex elbow fracture dislocations. Adv Orthop 2013:951397

    Article  PubMed  PubMed Central  Google Scholar 

  9. Floris S, Olsen BS, Dalstra M, Sojbjerg JO, Sneppen O (1998) The medial collateral ligament of the elbow joint: anatomy and kinematics. J Shoulder Elbow Surg 7(4):345–351

    Article  CAS  PubMed  Google Scholar 

  10. Hackl M, Beyer F, Wegmann K, Leschinger T, Burkhart KJ, Müller LP (2015) The treatment of simple elbow dislocation in adultsóa systematic review and meta-analysis. Dtsch Arztebl International 112(18):311–319

    Google Scholar 

  11. Hildebrand KA, Patterson SD, King GJ (1999) Acute elbow dislocations: simple and complex. Orthop Clin North Am 30(1):63–79

    Article  CAS  PubMed  Google Scholar 

  12. Hollinger B, Dehlinger F, Franke S (2014) Diagnostik und Therapie der ligamentären Ellenbogeninstabilitäten. Obere Extremität 9(3):147–155

    Article  Google Scholar 

  13. Hopf JC, Berger V, Krieglstein CF, Muller LP, Koslowsky TC (2015) Treatment of unstable elbow dislocations with hinged elbow fixation-subjective and objective results. J Shoulder Elbow Surg 24(2):250–257

    Article  PubMed  Google Scholar 

  14. Jeon IH, Kim SY, Kim PT (2008) Primary ligament repair for elbow dislocation. Keio J Med 57(2):99–104

    Article  PubMed  Google Scholar 

  15. Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1987) Surgical versus nonsurgical treatment of ligamentous injuries following dislocations of the elbow joint. Clin Orthop Relat Res 214:165–169

    Google Scholar 

  16. Kesmezacar H, Sarikaya IA (2010) The results of conservatively treated simple elbow dislocations. Acta Orthop Traumatol Turc 44(3):199–205

    Article  PubMed  Google Scholar 

  17. Kim BS, Park KH, Song HS, Park SY (2013) Ligamentous repair of acute lateral collateral ligament rupture of the elbow. J Shoulder Elbow Surg 22(11):1469–1473

    Article  PubMed  Google Scholar 

  18. Maripuri SN, Debnath UK, Rao P, Mohanty K (2007) Simple elbow dislocation among adults: a comparative study of two different methods of treatment. Injury 38(11):1254–1258

    Article  PubMed  Google Scholar 

  19. Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988) Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg Am 70(2):244–249

    Article  CAS  PubMed  Google Scholar 

  20. Micic I, Kim SY, Park IH, Kim PT, Jeon IH (2009) Surgical management of unstable elbow dislocation without intra-articular fracture. Int Orthop 33(4):1141–1147

    Article  PubMed  Google Scholar 

  21. Morrey BF (2012) Ligament injury and the use of hinged external fixators at the elbow. Instr Course Lect 61:215–225

    PubMed  Google Scholar 

  22. O’Brien MJ, Savoie FH 3rd (2014) Arthroscopic and open management of posterolateral rotatory instability of the elbow. Sports Med Arthrosc 22(3):194–200

    Article  PubMed  Google Scholar 

  23. O’Driscoll SW (1999) Elbow instability. Acta Orthop Belg 65(4):404–415

    PubMed  Google Scholar 

  24. Olsen BS, Sojbjerg JO, Dalstra M, Sneppen O (1996) Kinematics of the lateral ligamentous constraints of the elbow joint. J Shoulder Elbow Surg 5(5):333–341

    Article  CAS  PubMed  Google Scholar 

  25. Rafai M, Largab A, Cohen D, Trafeh M (1999) Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases. Chir Main 18(4):272–278

    CAS  PubMed  Google Scholar 

  26. Riel KA, Bernett P (1993) Simple elbow dislocation. Comparison of long-term results after immobilization and functional treatment. Unfallchirurg 96(10):529–533

    CAS  PubMed  Google Scholar 

  27. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 87(1):54–61

    CAS  PubMed  Google Scholar 

  28. Savoie FH 3rd, O’Brien MJ, Field LD, Gurley DJ (2010) Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Clin Sports Med 29(4):611–618

    Article  PubMed  Google Scholar 

  29. Schnetzke M, Aytac S, Studier-Fischer S, Grutzner PA, Guehring T (2015) Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study. J Orthop Surg Res 10:128

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stoneback JW, Owens BD, Sykes J, Athwal GS, Pointer L, Wolf JM (2012) Incidence of elbow dislocations in the United States population. J Bone Joint Surg Am 94(3):240–245

    Article  PubMed  Google Scholar 

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Correspondence to Thorsten Guehring.

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Schnetzke, M., Aytac, S., Keil, H. et al. Unstable simple elbow dislocations: medium-term results after non-surgical and surgical treatment. Knee Surg Sports Traumatol Arthrosc 25, 2271–2279 (2017).

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