Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study. [Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases].
Thirty consecutive patients who had dislocation of the elbow without concomitant fracture and who were sixteen years old or more were examined under general anesthesia for stability of the joint at an average of four days after the injury. All of the elbows showed medial and sixteen showed both medial and lateral instability. The patients were then randomly assigned to undergo either non-surgical or surgical treatment of the ligamentous injuries. All of the surgically treated elbows showed complete rupture or avulsion of both the medial and lateral collateral ligaments, and in about half of these patients the muscle origins were found to be torn from the humeral epicondyles. At follow-up, both groups showed generally good results; the differences were not statistically significant. There was no evidence that the results of surgical repair of the ligaments were any better than those of non-surgical treatment. Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization.
                50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization.
                We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups.
                Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence.
There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for simple dislocations of the elbow in adults. Although weak and inconclusive, the available evidence from a trial comparing surgery versus conservative treatment does not suggest that the surgical repair of elbow ligaments for simple elbow dislocation improves long-term function. Future research should focus on questions relating to non-surgical treatment, such as the duration of immobilisation.