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  The Open Orthopaedics Journal Content list available at: DOI: RESEARCH ARTICLE  Send Orders for Reprints to 452 The Open Orthopaedics Journal  , 2017, 11 , 452-459 Management Of Recent Elbow Dislocations: Functional Treatment Versus Immobilization; A Prospective Study About 60 Cases  Ndeye Fatou Coulibaly 1,* , Niane Mouhamadou Moustapha 2 , Hamadi Hadji Djoumoi 1 , Sarr Lamine 1 , Gueye Alioune Badara 1  and Sane André Daniel 1 1  Department of Orthopedics Traumatology CHU le DANTEC Dakar, Senegal  2  Department of Orthopedics Traumatology Regional Hospital of Thies, Senegal  Received: December 30, 2016Revised: March 10, 2017Accepted: April 16, 2017 Abstract: Objective: To determine our therapeutic posture trough a comparison of functional treatment results versus immobilization in two different  periods.  Introduction: For years, the treatment of recent elbow dislocations consisted of reduction and immobilization during 21 days. Given the frequency of stiffness other methods have been tried out.  Method: A prospective study was carried out from January 2010 to December 2014. Sixty patients averaging 28.3 years of age underwentelbow dislocation reduction. They were categorized into three separate groups. Patients in the first group had their elbowimmobilized for 21 days whereas Group 2 patients were immobilized for 10 days. Group 3 patients were applied a functionaltreatment followed by a functional rehabilitation. Patients were evaluated according to the Mayo Clinic Elbow Performance Indexand the results analyzed with statistical software (SPSS, version 18).  Results: During the first month, the functional results of the patients were excellent and good in 19%, 94.7% and 90% respectively for Groups1, 2 and 3. The pain was intense (10 on the visual analogue scale) in group 3 associated with swelling. At day 90, the results of the patients in Groups 2 and 3 were excellent in 100% of the cases versus 90% for Group 1. At 6 months, all the results were the same.We have not noted any instability, or recurrence or periarticular ossification in our patients. Conclusion: The treatment of stable elbow dislocations remains orthopedic. The risk of instability and pain motivates a short 10-day immobilization period followed by early mobilization. Keywords: Elbow, Dislocation , Reduction, Immobilization, Functional treatment, Rehabilitation. INTRODUCTION Dislocation represents 10% of elbow injuries [1], thus, ranking second in major dislocation cases after that of shoulder [2   , 3]. It is usually observed with adolescents and young adults [1]. It generally occurs during sports injuries * Address correspondence to this author at the Department of Orthopedics and Traumatology, CHU le DANTEC Dakar, Senegal; Tel: 00(221)775768613; Fax: 00(221)338342107; E-mails:    , 1874-3250/172017 Bentham Open   Management Of Recent Elbow DislocationsThe Open Orthopaedics Journal, 2017, Volume 11 453  by an indirect mechanism [4]. Their diagnosis is quite easy after a physical exam. In benign appearance, they aresometimes accompanied by bone, nerve and /or vascular lesions. In such cases, management issues are delicate and the prognosis reserved [1]. Orthopedic treatment through reduction and contention is left most of the time to lessexperienced hands [5]. Elbow contention may be explained as a way of maintaining reduction through stability provision and allowance for the healing of ligament within the first 21 post traumatic days. The brachio-forearm plaster,which is called strict immobilization, keeping the elbow flexed to 90 degrees during this period, is not withoutconsequences. Stiffness is the main complication, requiring long sessions of rehabilitation, reaching even arthrolysis toallow more or less complete functional recovery.This raises a set of problems linked to immobilization after elbow dislocation reduction. Some schools offer to letelbow free of any contention after a steady reduction or, at most, to set up a scarf [1, 6]; this method is also called functional treatment. Others limit the contention to 15 days [7 - 9]. But whatever the type of immobilization, rehabilitation is an important step in their management.The aim of our study was to determine a therapeutic stand by comparing the results of functional treatment versusimmobilization allowing two distinct periods after reduction. MATERIALS AND METHODS A prospective study covering a four-year period from January 1 st , 2010 to December 30 th , 2014 dealt with patientsreceived in emergency for recent traumatic elbow dislocation. Inclusion criteria ranged from isolated dislocations todislocations associated with a fractured radial head type 1 of Mason to fracture of the coronoid process type 1 of Morrey followed beyond 12 months. In total, 60 patients were selected.Average age was 28.3 years (ranging from 15 to 64 years) with a standard deviation of 11.7. There were 51 men and9 women with a sex ratio of 5.78. Sports injuries were a leading cause with 22 cases (36.7%), followed by householdaccidents (17 cases: 28.3%), highway accidents (13 cases: 21.7%), road traffic accidents (5 cases: 8.3%), accidents inthe workplace (2 cases: 3.3%) and 1 fight (1.7%). The mechanism was indirect through falling and landing on the hand palm in 86.7% of cases while other imprecise cases stood at 13.3%.Admission time averaged four hours after the trauma (range: 1 to 9 hours). This was an inaugural episode in allcases. Lesion in 36 cases (60%) concerned non-dominant upper extremity (27% right elbow and 73% left elbow). Allinjuries were closed.Radiographically, three types of dislocations were found: posterolateral dislocation in 47 cases (78%), followed bygenuine posterior dislocation (9 cases: 15%) and posteromedial dislocation (4 cases: 7%). Isolated dislocations werespotted in 48 cases (80%). Other patients showed associated injuries such as fractured radial head type 1 of Mason in 9cases (15%) and injuries related to coronoid process type 1 of Morrey in 3 cases (5%).Treatment consisted in reduction followed by contention.We randomly divided patients into three groups according to the contention mode (Table 1 ). Patients with afractured radial head or a fractured coronoid process, were randomized in the group of patients immobilized for 10 or 21 days. A rehabilitation and medical treatment protocol based on analgesic and anti-inflammatory was carried out inall cases. Indomethacin was not prescribed in any of the cases. Massages or any possible application on the elbow were proscribed especially in patients under scarf. Patients were revisited in relationship to relevant immobilization typerespectively on the following days: 7, 14, 30 and 90. In addition, a re-evaluation took place after six months and oneyear thereafter and on demand. Table 1. Repartition of groups according to type of contention. GNumber of patientsType of contentionMobilizationProtocol of reabilitationEvaluations1 21Splint plast whithin 21 DFrom D21Active motions helped by physiotherapistD21-30-90 2 20Splint plast whithin 10 DFrom D10Self-reabilitation by active motions and after, helped by physiotherapistD10-21-30-90 3 19ScarfFrom D1Self-reabilitation by active motionsD7-14-30-90G= group D= Day Patients were evaluated with the Mayo Clinic Elbow Performance Index [10]. Depending on final score, our resultswere classified as excellent, good, average or bad.  GROUP 1GROUP 2GROUP 3D180D90D45D30D21D10 140120100806040200 Evoluon of range of moon Degree 160 Statistical Analysis Results were analyzed with statistical software (SPSS, version #18). A paired T-test and logistical and linear regression analysis using the Pearson's Chi-squared test was also performed. The statistical test was consideredsignificant if the p value was below 0.05. RESULTS Dislocations were reduced within 15 minutes on average (range 10 to 75 minutes) after confirmation byradiography. The reduction was performed without anesthesia in 56 patients (93,3%), under sedative (diazepam)amongst 2 other patients (3.3%) while an additional 2 remaining patients (3.3%) were under general anesthesia.Protocol was carried out through external manipulations using the Fontaine technique [5]. Further, a testing was carried out in the flexion/extension arc on all patients whose reduction was performed without sedation (93,3%). Additionalvarus/valgus testing was applied on patients (6.6%) who had reduction under general anesthesia or sedation. These patients’ elbow was stable.All patients in Group 1 (G1) went on average through 12 sessions (ranging from 10 to 15) of functionalrehabilitation after the removal of the plaster with the assistance of a physiotherapist. A physiotherapist assisted four  patients in Group 2 (G2) through an average of five sessions (range: 3 and 7). A self-rehabilitation started on day 1 wasadequate for Group 3 (G3) patients. Evolutionarily, from day 30, global functional results obtained during short 10-dayimmobilizations (G2) and early mobilizations starting from day one (G3) were met (Fig. 1 ). Judging from the MayoClinic Elbow Performance criteria, they were excellent and good in 19%, 94.7%, and 90% respectively for group 1, 2and 3 (Table 2 ). Fig. (1). Evolution of range of motion. Table 2. Functional evaluation results on day 30. GroupsNumber of CasesSCORE OF THE MAYO CLINIC ELBOW PERFORMANCETotal  ExcellentGoogMediumBad G1 21 (35%)0%4(19%)7 (33,4%)10 (47,6%) 100% G2 20 (33,3%)14 (70%)4(20%)2 (10%)0% 100% G3 19 (31,7%)17 (89.4%)1(5.3%)1 (5.3%)0% 100% Total  60 (100 %) 31 (51.6%) 9 (15%) 10 (16.7%) 10 (16.7%) 100% G1: first group G2: second group G3: third group  D90D45D30D21D14D10D1 024Group 1Group 2Group 3681012 The results were statistically significant between G1 / G2 (p = 0.0001) and G1 / G3 (p = 0.0001). However, therewere no statistically significant differences between G2 and G3 (p = 0.579).During the first month, pain was intense; 10 on the Visual Analog Scale (VAS) associated with swelling in group 3.Pain evolution for each group is summarized in (Fig.  2 ). Fig. (2). Evolution of pain. At day 90, the functional results of Group 1 almost equaled those of the other two groups. At 6 months, functionalresults of the 3 groups were the same (Fig. 1 ). According to the Mayo Clinic elbow performance criteria results as of day 90 for patients in Groups 2 and 3 were excellent in 100% of cases versus 90% for Group 1 (Table 3 ). Nostatistically significant differences were found between G1 / G2 (p = 0,157) and G1 / G3 (p = 0,168). Table 3. Functional evaluation results on Day 90. GROUPSNUMBER OF CASESMAYO CLINIC ELBOW PERFORMANCE SCORETOTAL EXCELLENTGOODMEDIUMBAD G121 (35%)19 (90.47%) 2(9.53%)0%0% 100% G220 (33,3%)20 (100%) 0%0%0% 100% G319 (31,7%)19 (100%) 0%0%0% 100% Total  60 (100 %)58 (96.67%) 2 (3.3%) 0%0% 100% G1: first Group G2: second Group G3: third Group Regarding bone associated lesions, we found no differences between patients in the same group who had isolateddislocations on Day 30 and Day 90. No other complications (secondary displacement, malunion, periarticular ossification or osteoarthritis) were observed.With a retrospect of 2 years 9 months on average (range: 1 to 4 years), we observed no recurrence of elbowdislocation or instability. DISCUSSION It appears from this study that functional treatment (Group 3) and short 10-day immobilization period (Group 2) aresimilar in terms of elbow range of motion recovery. For Group 1 (21-day immobilization), the amplitude of patient’s Evolution of pain        P      a       i      n
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