Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2015; 6(7): 513-520
Published online Aug 18, 2015. doi: 10.5312/wjo.v6.i7.513
Cost analysis and outcomes of simple elbow dislocations
Michalis Panteli, Ippokratis Pountos, Nikolaos K Kanakaris, Theodoros H Tosounidis, Peter V Giannoudis
Michalis Panteli, Ippokratis Pountos, Peter V Giannoudis, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level A, Leeds LS1 3EX, United Kingdom
Nikolaos K Kanakaris, Theodoros H Tosounidis, Leeds Teaching Hospitals, University of Leeds, Clarendon Wing, Level A, Leeds LS1 3EX, United Kingdom
Author contributions: Panteli M, Kanakaris NK and Giannoudis PV designed the research; Panteli M, Pountos I and Tosounidis TH performed the research; Panteli M, Pountos I and Tosounidis TH analysed the data; Panteli M, Pountos I and Giannoudis PV wrote the paper.
Institutional review board statement: Institutional board approval (Leeds Teaching Hospitals Institutional Review Board; ID3050; 23/11/2010) was obtained for this study.
Informed consent statement: All involved subjects provided verbal informed consent prior to study enrolment. Data was anonymized and all study participants’ identifiable information was removed.
Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Consent for identifiable data sharing was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Michalis Panteli, MD, MRCS (Eng), Clinical Research Fellow, Honorary Lecturer, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level A, Great George Street, Leeds LS1 3EX, West Yorkshire, United Kingdom.
Telephone: +44-113-3430093 Fax: +44-113-3923290
Received: March 2, 2015
Peer-review started: March 3, 2015
First decision: April 10, 2015
Revised: May 12, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: August 18, 2015

AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.

METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level I trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation (LOI), patients were divided in three groups (Group I, < 2 wk; Group II, 2-3 wk; and Group III, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100° (from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.

RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d (median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d (median 57 d; range 10-351 d). Group III (prolonged immobilisation) had a statistically significant worse outcome in comparison to Group I and II (P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups I and II (P = 0.30). No statistically significant difference in the direct medical costs between the groups was identified.

CONCLUSION: The length of elbow immobilization doesn’t influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.

Keywords: Elbow dislocations, Simple, Management, Outcome, Cost analysis

Core tip: Our study demonstrates that prolonged immobilisation following simple elbow dislocations may lead to detrimental effects. We therefore stress the need for increased vigilance to the duration of immobilisation and that every effort should be taken to ensure that without associated fractures, the elbow should not be immobilised for more than three weeks. In addition, our study supports that the direct medical cost from treating these injuries may be substantial regardless of the type of treatment, and this should be known both by commissioners and providers of health care.