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Comparative Study of Simple and Complex Open Elbow Dislocations

  • Symposium: Traumatic Elbow Instability and its Sequelae
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Open elbow dislocations are rare injuries. Most of the evidence related to these dislocations is found in case reports or in series with closed injuries. We reviewed the experiences of three centers in the treatment of open elbow dislocations.

Question/purposes

We compared the results after operative treatment of simple and complex open dislocations in terms of (1) ROM, (2) functional score, and (3) complications.

Methods

Eighteen patients were retrospectively included in this study: 11 with simple open elbow dislocations and seven with complex open elbow dislocations. Mean age was 40 years. Thirteen were men. Eight patients presented neurovascular injuries. Evaluation included ROM of the elbow and forearm as measured by hand-held goniometer. We then classified the results using the 100-point Broberg and Morrey functional rating index based on ROM, grip strength, elbow stability, and pain. Scores of 95 to 100 were considered excellent, 80 to 94 good, 60 to 79 fair, and less than 60 poor. Complications were recorded. Minimum followup was 6 months (mean, 25 months; range, 6–72 months).

Results

We found no differences between simple and complex open elbow dislocations related to ROM (median flexion/extension: 117° versus 110°, p = 0.12; forearm rotation: 160° versus 170°, p = 0.67). According to the Broberg and Morrey score, four patients had excellent results, five good, and one fair in the simple dislocation group, whereas in the complex dislocation group, four patients had excellent results, two good, and one fair (p = 0.8). No difference in complication rate was found between groups (p = 0.63). All complications in the simple dislocation group were neurovascular. In the complex dislocation group, there was one case of brachial artery occlusion, two cases of heterotopic ossification, one case of infection and nonunion, and one case of infection. No patients had recurrent elbow instability.

Conclusions

No differences between simple and complex open elbow dislocations were found in terms of ROM, functional results, and rate of complications. Complications in the simple dislocation group were related to neurovascular injuries in contrast to the complex dislocation group where complications were associated with the bony injury.

Level of Evidence

Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of the Hand and Upper Extremity, Instituto de Ortopedia y Traumatología “Dr. Prof. Carlos Ottolenghi”, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Jorge G. Boretto MD, Gerardo Gallucci MD & Pablo De Carli MD

  2. Orthopedic and Traumatology Service, Clínica de Fracturas y Ortopedia, Mar del Plata, Argentina

    Mario Rodriguez Sammartino MD

  3. Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA

    David Ring MD, PhD

Authors
  1. Jorge G. Boretto MD
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  2. Mario Rodriguez Sammartino MD
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  3. Gerardo Gallucci MD
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  4. Pablo De Carli MD
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  5. David Ring MD, PhD
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Corresponding author

Correspondence to Jorge G. Boretto MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

The study was performed reviewing data from the medical records of the three institutions: Hospital Italiano de Buenos Aires (Buenos Aires, Argentina), Clínica de Fracturas y Ortopedia (Mar del Plata, Argentina), and Massachusetts General Hospital (Boston, MA, USA).

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Boretto, J.G., Rodriguez Sammartino, M., Gallucci, G. et al. Comparative Study of Simple and Complex Open Elbow Dislocations. Clin Orthop Relat Res 472, 2037–2043 (2014). https://doi.org/10.1007/s11999-014-3491-3

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  • DOI: https://doi.org/10.1007/s11999-014-3491-3

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