Prognosis
Shoulder dislocation
The incidence of recurrent instability for patients under 25 years of age, treated nonoperatively with or without sling immobilization, ranges from 50% to 95%.[46][94][95] In one study, patients with concurrent fractures of the greater tuberosity had an 8% recurrence rate.[46] The presence of Hill-Sachs lesions and bony Bankart lesions has also been reported to be associated with increased recurrence.[96]
Immobilization in external rotation does not appear to be more effective than immobilization in internal rotation following acute anterior shoulder dislocation.[97][98] [
]
Finger dislocation
Prognosis is negatively affected by the presence of concurrent fractures, irreducible dislocations, open injuries, and/or ligamentous or tendon injuries.
Patellar dislocation
The risk of recurrence after an acute dislocation, whether treated operatively or nonoperatively, has been estimated to range from 25% to 71% of patients. However, even with recurrent dislocations, approximately 75% of patients report good to excellent results with nonoperative treatment.[99][100][101]
Medial patellofemoral ligament (MPFL) reconstruction was associated with a high rate of success in one systematic review of the literature.[86] MPFL reconstruction leads to fewer recurrent dislocations than MPFL repair.[102] Both repair and reconstruction successfully returned patients to pre-injury activity levels.[102]
Elbow dislocation
Generally, elbow dislocation without associated fracture has a favorable prognosis when treated by closed reduction, and instability with stiffness is relatively rare.[33][88][89][90] With early range of motion, most patients regain normal function of the affected extremity.[91] Several studies have shown better outcomes with early mobilization than with immobilization in patients with simple dislocations.
Patients with concurrent fractures, particularly of the coronoid process and radial head, require surgical correction to stabilize the elbow. Even after operative intervention, functional outcomes are moderate to poor in more than 50% of patients with complex dislocations.[103]
Hip dislocation
Factors that influence the outcome include the extent of other severe injuries, the time to reduction, the direction of the dislocation, and the overall condition of the patient prior to dislocation.The outcome for individual patients depends largely on the development of late complications such as arthritis, osteonecrosis, and sciatic nerve palsy.[52]
Due to the high energy nature of native hip dislocations, they are seldom seen without concurrent injury.[38] Associated injuries have a negative prognostic effect on the clinical result. Sciatic nerve injuries are more common after fracture/dislocations when compared with pure dislocations. These injuries are usually partial, and most often affect the peroneal nerve distribution. Resolution after reduction of the dislocation is the rule, and exploration is not required unless nerve function was intact before the reduction and then lost afterward.[104]
Isolated anterior dislocations without femoral head fracture or injury have a better prognosis than similar posterior dislocations.[52]
The most important prognostic factor is generally thought to be the time to reduction, as this directly correlates with subsequent risk of developing osteonecrosis of the femoral head, which is a poor prognostic indicator of clinical outcomes.[38] The rate of osteonecrosis following hip dislocation varies widely. If the hip is reduced within 6 hours, the rate is approximately 2% to 10%.[52] One meta-analysis found that if the hip is reduced after 12 hours, the risk of developing osteonecrosis is 5.6 times greater versus reduction prior to 12 hours. When osteonecrosis occurs, it usually appears within 2 years of the injury, but has been observed as long as 8 years after injury. Patients, therefore, should be followed with imaging to monitor for signs of osteonecrosis.[52]
Arthritis is the most common complication in patients who have sustained a traumatic hip dislocation, and has been estimated to affect 20%. It probably results from articular cartilage injury during the initial dislocation.[52]
Femoroacetabular impingement is another potential complication, although incidence is unknown. Patients less than 50 years old should be followed for its development. Although either cam or pincer type impingement, or a combination, may develop, cam impingement is more common in this population.[52]
Recurrent hip dislocations following an initial simple hip dislocation are rare, with an incidence rate of only 1%.[52]
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