Early Outcomes of Pediatric Elbow Dislocation-Risk Factors Associated With Morbidity.

INTRODUCTION

Ulnohumeral elbow dislocation is a rare elbow injury in children. We reviewed a large cohort of pediatric ulnohumeral elbow dislocations and sought to identify risk factors associated with poor functional outcomes.

METHODS

Medical charts and radiographs were reviewed for all acute pediatric ulnohumeral elbow dislocations evaluated at our facility during a 7-year period. Charts were abstracted for demographics, injury characteristics, treatments, and complications. Functional outcomes were assessed at minimum 6-week follow-up using a combination of symptoms and elbow range of motion (Roberts criteria).

RESULTS

A total of 145 cases qualified for inclusion and were analyzed. The average age at injury was 11 years (range, 5 to 18 y), with equal distribution between male and female individuals. Concomitant elbow fractures were identified in 114 (80%) cases; the most common was the medial epicondyle (80/134, 60%). Treatment consisted of open reduction and fixation of associated fracture(s) in 59% of fracture cases. At an average follow-up of 3.7 months, the average range of motion was -5-degree extension to 126-degree flexion. Immobilization for longer than 2 weeks resulted in a loss of elbow extension (P<0.001). Functional outcomes as assessed by the Roberts criteria were good or excellent in 90% of cases. Risk factors associated with less than excellent functional outcomes included the presence of multiple fractures (P=0.001), the need for operative intervention (P=0.01), and the duration of immobilization (P=0.03). Complications requiring further treatment occurred in 16 cases (11%). Patients without complication resulted in a higher proportion of "excellent" functional outcomes (76%) compared with those with a complication (40%) (P<0.001).

CONCLUSIONS

The majority of pediatric ulnohumeral elbow dislocations experience good to excellent functional outcomes by early follow-up. Risk factors associated with less than excellent functional outcomes include the presence of multiple associated fractures, operative intervention, and prolonged immobilization. Complications requiring operative intervention are not rare, and have a significant effect on functional outcomes.

LEVEL OF EVIDENCE: Level IV-prognostic.