O3253: Longer Immobilization Increases the Risk of Stiffness in Children with Elbow Dislocation

Background: Ulnohumeral (elbow) dislocations are uncommon injuries in children that can lead to poor outcomes, including joint contracture and instability. While the incidence of ulnohumeral elbow dislocations has been reported, outcomes following conservative treatment are less well-described. Previous studies have found varying conclusions in terms of the appropriate duration of immobilization due to inclusion of both operatively and non-operatively-managed patients. Thus, there is little consensus on the duration of immobilization necessary to ensure the best outcomes. This study aims to estimate incidence and identify risk factors for stiffness in non-operatively-managed patients. We hypothesize that greater length of immobilization will be a risk factor for elbow stiffness.

Methods: A retrospective cohort study of children with ulnohumeral elbow dislocations treated non-operatively from 2010-2024 at a single children’s hospital was conducted. Patient records and radiographs were reviewed for demographics, treatments, and complications. Patients who failed to achieve a return to functional range of motion (≥120 degrees arc of motion) were included if they had a minimum of 3 months of follow-up. Patients were excluded if they had a metabolic bone disorder, congenital dislocation, or underwent initial operative treatment for the acute dislocation or an associated fracture. Descriptive analysis was performed to determine the incidence of elbow stiffness, and Fisher tests, Wilcoxon Rank Sum tests, and Logistic Regression analysis were used to identify associated risk factors.

Results: 101 patients (52% female) with a median age of 10.4 (IQR: 8.5-13.8) years were included (Table 1). The majority of the patients had a posterior or posterolateral elbow dislocation (95.0%; 96/101), while 3.0% (3/101) had a posteromedial dislocation and 2.0% (2/101) had an anterior dislocation. 58.4% of cases were true “simple” elbow dislocations with no associated fracture (59/101). Fractures of the inferior pole of the medial epicondyle (15.8%) and coronoid (10.9%) were the most common associated fractures. The overall incidence of posttraumatic stiffness (overall arc of motion < 120°) was 12.8% (13/101). Age, sex, and associated fracture did not increase risk of stiffness. The median length of immobilization was significantly greater for those who experienced elbow stiffness (22.0 vs. 15.0 days, p=0.019). The odds of elbow stiffness were 5.08 times greater among patients who had ≥20 days of immobilization (p=0.007). Four patients underwent downstream surgery due to the severity of joint contracture. A single patient experienced recurrent posterolateral rotatory instability due to insufficiency of the lateral ulnar collateral ligament (LUCL) and also required surgery (Figure 1).

Conclusion: The overall incidence of elbow stiffness (range of motion < 120) was 12.8%. Prolonged immobilization (>3 weeks) increased the risk of contracture by fivefold. Thus, early mobilization is important to avoid joint stiffness in children with elbow dislocations.