Background
We have previously reported on the medium-term outcomes following a non-operative
protocol of a short period of splinting followed by early movement to treat simple
dislocations of the elbow. While the outcomes were not entirely benign with some patients
reporting persistent pain and stiffness, patients reported excellent functional outcome scores,
satisfaction and demonstrated normal or near-normal range of movement, with very little
requirement for secondary surgery.
There is considerable discussion about the role for primary ligament repair in the treatment of
these injuries and which patients or injury patterns might benefit most from surgery. We
undertook extended follow up of our original patient study group to determine whether the
excellent results previously reported were maintained in the very long-term. A secondary
question was to determine the rate and need for any late surgical intervention.
Methods
We attempted to contact all patients in the original patient study group. Patients were
requested to complete the Oxford elbow score (OES), the Disabilities of the Arm, Shoulder
and Hand (DASH) questionnaire and a validated patient satisfaction questionnaire. Patients
were requested to attend a face-to-face assessment where they underwent a clinical
examination including neurovascular assessment, range-of-motion and an assessment of
ligamentous stability.
Results
Seventy-one patients from the original patient study group agreed to participate in the study.
The mean duration of follow-up was 19.3 months. At final follow-up patients reported
excellent functional outcome scores and a preserved functional range of movement in the
injured elbows. The mean DASH score was 5.22 points and the mean Oxford Elbow Score
was 91.6 points. The mean satisfaction score was 90.9 points.
Conclusions
Our study shows that the excellent outcomes following treatment with a protocol of a short
period of splinting and early movement remain excellent and are maintained into the very
long term. These findings support our hypothesis that this treatment protocol is appropriate
and suitable for most patients with simple dislocations of the elbow. This might suggest that
with such excellent functional outcomes into the very long term, the role for primary
ligamentous repair for this patient group should be carefully considered. Surgery may not be
necessary for most patients with this injury and work to more clearly define the anticipated
benefits of surgery for specific patient groups or injury patterns would help to support
informed decision making.