van der Horst Anna S, Stephens Andrew R, Wei Guo, Presson Angela P, Tashjian Robert Z, Kazmers Nikolas H
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
OrthoIndy Trauma, Ascension St. Vincent Hospital, Indianapolis, IN.
J Hand Surg Glob Online. 2021 Sep;3(5):260-265. doi: 10.1016/j.jhsg.2021.05.011. Epub 2021 Jun 24.
To describe patient-reported outcomes following simple elbow dislocation and to identify the baseline factors that predict outcomes.
Adult patients treated with a closed reduction for a simple elbow dislocation with or without minor fracture (coronoid avulsion, radial head fracture, or epicondyle avulsion) from 2000 to 2018 completed outcome instruments including Disabilities of the Arm, Shoulder and Hand (DASH) via Research Electronic Data Capture. Descriptive statistics were calculated. Univariate followed by multivariate Tobit regression models were used to determine factors associated with clinical outcomes on DASH. Social deprivation was measured using the Area Deprivation Index. Patients with additional upper-extremity injuries or associated major fractures (Monteggia or terrible triad injuries, distal humerus fractures, etc) were excluded.
At a mean follow-up of 67.5 months, 95% (38/40) of patients reported satisfaction with treatment, and clinical outcomes were good (DASH 9.0 ± 14.8). Univariate analysis showed that higher Area Deprivation Index, older age, female sex, high-energy mechanism of injury, and worker's compensation (WC) or Medicare insurance status (vs commercial) was associated with significantly worse DASH scores at follow-up. Early therapy, dominant elbow involvement, presence of minor fractures (minimally displaced radial head, coronoid tip, or epicondylar avulsion fractures), race, and treating service did not influence outcomes in univariate analyses. Multivariate analysis demonstrated a significant association between increased social deprivation, WC insurance, and Medicare insurance and worse DASH scores while controlling for new upper-extremity injury, age, sex, and mechanism of injury.
Outcomes and treatment satisfaction following simple elbow dislocation are generally good but are significantly worse for the patients with greater levels of social deprivation and WC or Medicare insurance. Although surgeons should be aware of the possibility that specific subsets of patients may benefit from early therapy, this factor did not appear to influence long-term outcomes in this small cohort.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
描述单纯肘关节脱位患者报告的结局，并确定预测结局的基线因素。
2000年至2018年接受闭合复位治疗的单纯肘关节脱位（伴或不伴轻微骨折，如冠状突撕脱、桡骨头骨折或髁上撕脱骨折）的成年患者通过研究电子数据采集系统完成了包括上肢、肩部和手部功能障碍（DASH）在内的结局评估工具。计算描述性统计数据。采用单因素分析，随后进行多因素 Tobit 回归模型，以确定与 DASH 临床结局相关的因素。使用地区剥夺指数衡量社会剥夺情况。排除合并其他上肢损伤或相关严重骨折（孟氏骨折或可怕三联征损伤、肱骨远端骨折等）的患者。
平均随访67.5个月时，95%（38/40）的患者对治疗表示满意，临床结局良好（DASH评分为9.0±14.8）。单因素分析显示，较高的地区剥夺指数、年龄较大、女性、高能量损伤机制以及工伤赔偿（WC）或医疗保险状态（与商业保险相比）与随访时显著较差的DASH评分相关。早期治疗、优势侧肘关节受累、存在轻微骨折（轻度移位的桡骨头、冠状突尖或髁上撕脱骨折）、种族和治疗科室在单因素分析中未影响结局。多因素分析表明，在控制新的上肢损伤、年龄、性别和损伤机制的情况下，社会剥夺增加、WC保险和医疗保险与较差的DASH评分之间存在显著关联。
单纯肘关节脱位后的结局和治疗满意度总体良好，但社会剥夺程度较高以及有WC或医疗保险的患者结局明显较差。虽然外科医生应意识到特定患者亚组可能从早期治疗中获益的可能性，但在这个小队列中，该因素似乎并未影响长期结局。
研究类型/证据水平：预后性研究III级
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