Title: Outcome of neglected elbow dislocation treated with open reduction at rural tertiary care hospital in Nepal

Biography:

Mangal Rawal has completed his bachelor in medicine from B.P. Koirala Institute of Health Science, Dharan, Nepal. He has completed master in orthopedic surgery from National Academy of Medical Sciences, Kathmandu. He also has completed his fellowship in trauma and illizarov from National Institute of Trauma and Rehabilitation (NITOR), Dhaka, Bangladesh. Currently he is working as a head of department of orthopedics and trauma at Karnali Academy of Health Sciences which is one of the pioneer tertiary care institution in rural Nepal. He is taking a responsibility as a health policy advisor of provincial government of Karnali province.

Abstract

According to many kinds of literature published, the old unreduced dislocation of the elbow is a rare condition. But it seems more frequent in developing countries due to lack of awareness among the patient population who believe in traditional faith healers and lack of proper health facilities. Our institute is located in the most rural parts of Nepal so that the incidence of neglected dislocation of elbow might be more common than other parts. Neglected elbow dislocation has a great impact on the activity of daily living. Open reduction of neglected elbow dislocation, most of the time, leads to less than expected outcome. There are several methods by which neglected dislocation can be treated. We have compared the functional outcome of 11 cases of neglected dislocation treated with open reduction and trans olecranon K wire fixation over a period of 3 years.

Material and methods: 11 consecutive cases of neglected elbow dislocation presented to our institute were evaluated and treated with open reduction and K wire fixation. The functional outcome was measured with MEPI scores. Preoperative and postoperative extension, flexion and range of motion were evaluated. Associated surgical complications were also studied.

Results: 7 patients had a history of fall from height and 4 patients presented with slipped fall on the ground. Average time of presentation after trauma was 6.18 month. The average age of the patient was 28.2 years. MEPI has increased from 15.45 preoperatively to 87.27 postoperatively. No major complication associated with the treatment except one case of the unstable elbow.

Conclusion: Open reduction and K wire fixation provide a good functional outcome in a neglected elbow dislocation of more than 3 weeks duration.