Management of Neglected Elbow Dislocations in a Setting with Low Clinical Resources

Abstract

To investigate the effect of open reduction operative treatment in neglected elbow dislocation. Between January 2009 and October 2010, 13 patients (mean, 27 years, nine men and four women) with old unreduced posterior dislocation of the elbow were treated by open reduction and removal of fibrous tissue between distal humerus and ulna with Kirschner wire fixation with or without triceps lengthening in our hospital. The patients were followed up for a mean of 18 (range, 14-22) months. The mean operating time was 69.53 (range, 56-90) min. Mean operative blood loss 361.53 mL (range, 300-450 mL), mean tourniquet time 51.92 min (range, 46-70 min). According to the Mayo Elbow Performance Index at the final follow-up, 11 patients had satisfactory outcomes (six excellent, five good) and two patients had unsatisfactory outcomes (one fair and one poor). The mean score was 87. Nine patients had no pain, two had mild pain during repetitive elbow movements or weight lifting, and two had moderate pain. The mean pain score was 38 (range, 15-45). At the final follow-up, two patients had signs of instability; the mean score was 15. Seven achieved a flexion range of 105° to 130°, two achieved 100°, two achieved 95°, one achieved 80°, and one 60°. Operative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable and functional limb.