Complications

Complication
Timeframe
Likelihood
variable
high

The incidence of recurrent instability for those under 25 years of age, treated nonoperatively with or without sling immobilization, ranges from 50% to 95%.[46][94][95]

Inadequate analgesia is a common reason for failure in attempts to reduce a shoulder.

variable
high

This is a compression fracture on the posterolateral corner of the humeral head, which is caused when the humeral head impinges against the glenoid (scapula) of the shoulder joint.[105]

Hill-Sachs lesions occur in 47% to 65% of primary shoulder dislocations.[105]

Large Hill-Sachs lesions are associated with recurrent joint instability.[96]

variable
high

These are avulsions of the glenoid labrum and its attachment to the inferior glenohumeral ligament. This ligament is a primary restraint of the humerus to anterior/inferior translation when the arm is in abduction.[106]

Avulsion of the capsular restraints to the humeral head contributes to the incidence of instability after a dislocation.

Bankart lesions occur in up to 78% of primary shoulder dislocations.[106]

Large Bankart lesions are associated with recurrent instability.[96]

variable
high

Elbow dislocation with associated fractures, particularly of the radial head and coronoid, often results in significant instability of the joint.[103]

variable
high

Fractures, particularly of the radial head and coronoid, are found in approximately 20% to 50% of elbow dislocations.[33][103]

Posterior dislocation of the elbow associated with a fracture of the coronoid process and fracture of the radial head is described as the "terrible triad."

variable
high

Approximately 35% of patients managed conservatively for primary dislocation of the patella experience recurrence.[111][112]

variable
low

These occur in 11% to 28% of acute shoulder dislocations and are associated with worse prognosis.[83][106]

Older patients are more likely to sustain rotator cuff injuries, and early MRI scan may be helpful to rule out this associated pathology.[41][82][83]

Rotator cuff injury

variable
low

The incidence of axillary or brachial plexus injuries associated with acute shoulder dislocation is approximately 4%.

However, most are palsies and resolve within 3-6 months.[107]

variable
low

Brachial and/or axillary artery injuries present with the pathognomonic triad of anterior shoulder dislocation, a diminished or absent pulse, and expanding axillary mass.

This typically occurs in older patients due to loss of elasticity of the vessels.

Any patient presenting with this triad requires emergent vascular consultation and an angiogram.[108]

variable
low

These occur in 7% of shoulder dislocations and, if displaced more than 0.5 cm, they require surgical fixation.[109]

Early follow-up is important, as nondisplaced fractures may displace prior to healing.

variable
low

The median, ulnar, or radial nerve can be damaged following elbow dislocation, but most cases are neuropraxias and typically resolve.

However, if a deficit appears after reduction of the elbow, consultation with orthopedics is warranted for emergent exploration of the affected nerve.[15]

Brachial plexus injury

variable
low

Brachial artery injury is an extremely rare but devastating complication of elbow dislocation.

If a patient presents with an asymmetric pulse, immediate reduction should be performed, with assessment of pulses postreduction and referral to a vascular surgeon.

If pulses do not return, the patient requires immediate surgical intervention to repair the artery.

variable
low

Several studies have shown better outcomes with early mobilization than with immobilization in patients with simple dislocations of the elbow.

Patients should initially be splinted in a posterior splint for comfort, with instructions to begin mobilization when pain allows. Immobilization should last no longer than 2 weeks.[33][88][89][90][91]

variable
low

These occur as cartilage covering the end of a bone in a joint (articular cartilage) is torn.

One case series found 95% of patients with lateral patellar dislocation showed some degree of articular cartilage injury; cracks with osteochondral fracture were seen in 54% of knees. Other studies have reported rates of between 40% and 76%.[110] Damage can occur as a result of reduction in addition to the initial dislocation.

Large osteochondral injuries require internal fixation, while small injuries may require arthroscopic debridement.

Therefore, orthopedic consultation is necessary should an osteochondral injury occur.

variable
low

Other ligamentous structures around the knee can be concomitantly injured.

variable
low

Stiffness in finger dislocation is more common than instability and patients can experience residual pain and stiffness for 6-12 months after injury.[44][55][59]

In treating finger dislocation, instituting early motion and providing stability must be balanced.

variable
low

Chronic dorsal proximal interphalangeal dislocation may result in a swan neck deformity of the finger.[55]

variable
low

Chronic volar proximal interphalangeal dislocation injuries may result in a Boutonniere deformity.[55]

variable
low

May occur after a hip dislocation and is a poor prognostic indicator of clinical outcomes.

Studies have documented an osteonecrosis rate of 4.8% when the hip is reduced less than 6 hours after injury; whereas, a rate of 52.9% has been documented in hips reduced more than 6 hours after injury.[104]

When osteonecrosis occurs, it usually appears within 2 years of the injury, but has been observed as long as 5 years after injury. Patients, therefore, should be followed with imaging to monitor for signs of osteonecrosis.

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