Abstract
Objectives
To evaluate management, direct-medical-costs and clinical outcome profile of a large trauma unit with respect to simple elbow dislocations.
Methods
All simple elbow dislocations that were defined as not requiring acute surgical intervention, post-reduction, were considered between Jan-2008 and Dec-2010. Inclusion criteria consisted of age greater than 13; absence of major associated fractures, successful closed reduction, and follow-up as an outpatient. The management of these patients was classified in terms of immobilisation time into: short (< 2weeks), standard (2–3weeks) and prolonged (>3weeks). Direct-medical-costs were calculated based on current tariff rates associated with radiology, admission, theatre time (for reductions and recovery) and outpatient attendances. Clinical outcome was evaluated with respect to complications, secondary procedures, and time before discharge from clinic.
Results
Of 81 patients in total, 6% required reduction in theatre, 17% admission, 9% were referred to a specialist or had a complication and 42% DNA their final appointment. The mean length-of-immobilisation was 2.25weeks (range 0–6weeks). The median direct-medical-cost was £893 per patient (range £418-£2,693). The median duration of patients' engagement with hospital services was 57days (range 3–831). There was no statistically significant relationship between length-of-immobilisation and time-before-discharge (p=0.42), or associated direct-medical-cost (p=0.586). In terms of clinical outcome the prolonged immobilisation group had a statistically significant worse outcome in comparison to the short (p=0.30) and the standard (p=0.01). The comparison between standard immobilisation and short resulted in a marginally (p=0.08) significant advantage of the first.
Conclusion
Prolonged elbow immobilisation is generally associated with increased stiffness and a higher rate of complications. For simple elbow dislocations time-to-mobilisation was variable, as well as the mode of follow-up. The use of standardised protocols of treatment is essential in these type of injuries that are usually managed in an outpatient basis, to minimise the variability between clinical teams, improve outcome, and minimise costs
