Functional Outcomes of Neglected Elbow Dislocation Treated with Double Approach Surgery

Abstract

Tito Sumarwoto,1 Seti Aji Hadinoto,1 Dina Aprilya,2 Sigit Bayudono,3 Totok Siswanto3 1Orthopaedic Upper Limb and Microsurgery Division, Orthopaedic & Traumatology Departement, Prof. DR. R. Soeharso Hospital, Surakarta - Faculty of Medicine Sebelas Maret University, Surakarta, Indonesia; 2Orthopaedic & Traumatology Department, Fatmawati General Hospital, Jakarta, Indonesia; 3Orthopaedic & Traumatology Department, Faculty of Medicine Sebelas Maret University, Surakarta, IndonesiaCorrespondence: Tito Sumarwoto, Prof. Dr. R. Soeharso Orthopedic Hospital, Central Java, Indonesia, Email [email protected]: Neglected elbow dislocation is common in developing countries. The chronic nature of the disease results in a level of complexity that makes treatments and outcomes contradictory. Several treatment methods have been described for neglected elbow dislocations. The goal of this study was to evaluate the results of neglected elbow dislocations treated using the double approach of reduction and K-wire fixation.Methods: This series included patients with neglected elbow dislocations who were treated with open reduction using double approaches (medial and lateral incisions) between November 2020 and March 2021. Patients were evaluated for a minimum of 6 months to ascertain functional recovery in accordance with the Mayo Elbow Performance Index (MEPI) and Disability of Arm, Shoulder, and Hand (DASH) score.Results: Nine patients with neglected elbow dislocations were included in the study, with an average delay of 3.44 months. Four patients had an excellent MEPI and five had a good score at the final follow-up, with a mean MEPI score of 86.67. The average DASH score was 36 (31– 59). Five patients (55.56%) experienced no pain, but four patients (44.44%) had mild pain, with a range of pain points of 30– 45. The motion arc improvement was 60°– 100°, with a mean of 74.44°. Almost all of the patients (eight patients, 88.89%) had elbow stability, but one patient had ulnar nerve paresthesia postoperatively. Heterotopic ossificans was associated in 1 patient, and triceps lengthening was needed in 1 patient; both came 5 months later.Conclusion: Open reduction surgery with a double approach offers a good chance of a good result with few side effects and should be considered for all patients who have this condition.Keywords: elbow, neglected dislocation, open reduction, surgical approach, functional outcome

Keywords

• elbow
• neglected dislocation
• open reduction
• surgical approach
• functional outcome