• 
• 

Three Part Question

In [an adult who has had a dislocated elbow reduced] is [collar and cuff or an above elbow plaster] better at [reducing pain, recurrence and post-reduction complication]?

Clinical Scenario

A 24 year old woman presents to the emergency department following a fall on her left arm. Clinical and radiological examination reveals a posterior dislocation of the elbow joint. You reduce this in the department using propofol for sedation. You wonder what form of immobilisation should be used. In the past you have used a collar and cuff but your SHO (who has just done orthopaedics) states that the patients should have an above elbow plaster cast.

Search Strategy

Medline 1966-01/04 using the Ovid interface.
[exp elbow joint OR elbow.mp. OR exp elbow] AND [dislocation.mp. OR exp dislocations OR dislocat$.mp.] AND [exp Immobilization/ OR immobilisation.mp. OR (collar and cuff).mp. OR exp Casts, Surgical/ OR plaster.mp OR plaster of paris.mp.] LIMIT human AND English language.

Search Outcome

Altogether 89 papers were found of which none were relevant to the original question.

Comment(s)

This is a real life scenario. Our current practice is to initially immobilise using a collar and cuff withor without a wool and crepe bandage. In the abscence of fracture or significant ligamental rupture, the biomechanics of the elbow should result in stability once reduced.

Clinical Bottom Line

There is no published evidence. Local advice (collar and cuff in our case) should be followed.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.