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Plaster or collar and cuff after reducing dislocated elbow
  1. Katherine Potier, Specialist Registrar,
  2. Simon Carley, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

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    Report by Katherine Potier, Specialist RegistrarChecked by Simon Carley, Consultant

    Abstract

    A short cut review was carried out to establish whether an above elbow plaster cast was better than a collar and cuff sling after reduction of a dislocated elbow. No papers addressing this question were found using the reported search.

    Clinical scenario

    A 24 year old woman presents to the emergency department after 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.

    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]

    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 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 with or 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.

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