O2204 PAEDIATRIC ELBOW DISLOCATION

Abstract

Aims: To review paediatric elbow dislocations treated in our institution over a ten year period in terms of incidence, aetiology, management and follow up. Methods: Prospective data collected on elbow injuries in our unit was used to identify elbow injuries and elbow dislocations over a ten year period. This was followed by a case note and x ray review. Results: 1761 elbow injuries exclusively treated in our unit in a ten year period. Of these patients 63 had elbow dislocations. We found a male to female preponderance of around 2:1 (44:19), left more common than right (37:26). There was a seasonal variation with more injuries in the summer months. 80% of all dislocations occurred as a result of a low fall or simple sporting injury. 60 of the 63 dislocations were posterior with 2 anterior and 1 divergent dislocation. Associated fractures were common with 33% of patients having a medial epicondylar fracture in association with their dislocation, other fractures were rare. 2 dislocations were open; there were 2 neuropraxias and no vascular complications. 12 cases were reduced with sedation and analgesia with the remainder undergoing general anaesthetic. Closed reduction was possible in all cases Those patients with associated fractures of the medial epicondyle who underwent reduction under sedation had a much higher requirement of open reduction of the fragment (3 out of 4) compared with those having reduction under general anaesthesia (4 out of 16). Post operative management consisted on average of 3 weeks in plaster. In the timeframe used there were no - recurrent dislocations, no patients re referred for assess- ment of ongoing elbow problems and no complaints of ongoing stiffness. Conclusions: Paediatric elbow dislocations represent around 3.5% of all paediatric elbow injuries, are more common in boys and on the left. They generally arise from low energy trauma and are usually posterior. Closed reduction we found always to be possible but if there was an associated fracture then reduction is probably best carried out under general anaesthesia since this appears to aid reduction of associated fragments.