Early Mobilization of Simple Elbow Dislocations

Commentary The retrospective study by Mackinnon achieved a mean of 19 years of follow-up of 64.5% (71) of a previously studied cohort of 110 patients with a simple elbow dislocation that had been treated with early mobilization. It confirmed the results of previous studies on this subject, while adding the value of patient-reported outcome measures as a metric of the success of nonoperative treatment and a short period of immobilization after elbow dislocation. Josefsson et al. published one of the longest-term outcome studies of this problem in JBJS in 19841. In a cohort of 52 patients (84% of an original group of 62 patients) with a mean of 24 years of follow-up, the authors showed that there was a mean loss of extension of 8°, with very minimal degenerative changes; however, over half of these patients were <16 years of age at the time of dislocation. One of the most compelling studies supporting early mobilization after simple elbow dislocation is the multicenter randomized trial conducted by Iordens et al. in The Netherlands, with comparison of a bandage and an optional sling for 7 days, with early motion at 2 days, versus 3 weeks of plaster casting in 100 patients. Short-term pain, the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, and range of motion were significantly better at 6 weeks in the early mobilization group, with similar results between the groups at 1 year2. A recent systematic review of the literature confirmed early return of range of motion and function, as well as quicker return to work, in patients with early mobilization after dislocation3. Animal studies have added to the evidence for this approach to simple elbow dislocation. In a study of traumatic elbow dislocation in rats, longer immobilization resulted in reduction of range of motion, with increased cellularity, fibrosis, and thickening of the joint capsule4. The current study by Mackinnon et al. also evaluated sex differences in outcomes measures, noting that women reported lower functional outcome scores and satisfaction than men at long-term follow-up, despite overall excellent metrics in both sexes. This difference was noted in the earlier cohort study with a mean follow-up of 7 years5, and persisted into the long term in the current study, with no relationship to final range of motion. Further exploration of this difference is warranted and represents an area for future research.