Evaluation of risk factors for stiffness after distal humerus plating

Tunalı, Onur; Erşen, Ali; Pehlivanoğlu, Tuna; Bayram, Serkan; Atalar, Ata Can; Demirhan, Mehmet

doi:10.1007/s00264-018-3792-3

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…In a retrospectively study, Hong et al [15] examined the heterotopic ossi cation after elbow fracture surgery and reported that the risk of heterotopic ossi cation increased 10.62 times when the time to surgery was more than seven days. In another study, Tunalı et al [11] evaluated risk factors for stiffness after distal humerus plating and found that patients with the time to surgery > seven days were more likely (2.59 times) to suffer elbow stiffness. Similarly, Lindenhovius et al [28] compared the acute and subacute treatment of TTI and showed that earlier management could obtain a better exion arc.…”

Section: Discussionmentioning

confidence: 99%

“…Specially, in recent years, with the increased knowledge of elbow biomechanics, the advancement of xation techniques, and the application of standardized surgical protocols, the satisfactory outcomes have been reported by many studies [7][8][9]. However, the complication rate after operative treatment of TTI was reported as high as 50% [4,5], especially the elbow stiffness, which obvious impairs the patients' activities of daily living [10][11][12]. Morrey reported that an arc of elbow motion between 30° and 130° is required for 90% of daily activities and loss of 50° arc of motion would result in up to 80% of functional loss [13].…”

Section: Introductionmentioning

confidence: 99%

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What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Zhu

Deng

Cheng

et al. 2021

Preprint

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Background: The elbow stiffness is a common complication after operation of terrible triad injury (TTI) and significantly impair the patients’ activities of daily living, while the risk factors have yet to be clearly identified. The goal of this study was to examine the patient-related, injury-related, and treatment-related factors for elbow stiffness after operation of terrible triad injury.Methods: Between January 2013 and December 2019, 71 patients at two tertiary-care referral centers underwent operation of terrible triad injury were respectively reviewed. Range of motion (ROM), Mayo elbow performance scores (MEPS), Broberg-Morrey scores were used for functional evaluation. According to the ROM, the patients were categorized into stiffness group and non-stiffness group. The former had < 100° of extension-flexion ROM and the latter had > 100°. The patient-related, injury-related, and treatment-related factors were extracted from the medial records. The multivariant logistic regression were performed to identify the independent factors.Result: At a mean follow-up of 35.9 months (12-68 months),13 patients were classified into the stiffness group and 58 patients in the non-stiffness group. The stiffness group had significant worse functional scores compared to the non-stiffness group. Patients in the stiffness group were more likely to be Mason type III fracture, high-energy injuries, to have longer time between injury and surgery, ipsilateral upper limb injuries, and other fractures in body. However, multivariant logistic regression analysis revealed that time between injury and surgery > seven days, concurrent ipsilateral upper limb injuries and high-energy injury were independent factors that increased the risk of elbow stiffness after operation of terrible triad injury.Conclusions: The patients underwent operation for terrible triad injury should be informed the probability of elbow stiffness when concurred ipsilateral upper limb injuries and operations should be conducted without delay. Knowledge of these risk factors will be helpful for guiding prophylaxis and early intervention in patients with high risk of elbow stiffness after operation of terrible triad injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Zhu

Deng

Cheng

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The intercondylar distal humerus fracture was the most severely comminuted and complex pattern among all other fractures. And despite achieving the best anatomical reduction and absolute fixation, this fracture pattern carries the highest risk of post-traumatic joint stiffness and is usually associated with flexion contracture [12]. Poor patient compliance and low threshold to pain tolerance are the important factors limiting the early joint mobilization and thus allowing periarticular fibrosis and flexion contractures.…”

Section: Discussionmentioning

confidence: 99%

Sequence of Fixing Fractures Involving all the Three Major Joints of the Upper Limb: A Case Report

Sehrawat

Bansal

et al. 2021

JOIO

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A 29-year-old lady accidentally fell from the first floor at home, sustained multiple fractures all on the left side which were the proximal humerus fracture, inter-condylar distal humerus fracture, intra-articular distal end radius fracture, and acetabulum fracture. She was actively managed following Advance Trauma life Support (ATLS) protocol and once stabilised was operated in a stage-wise manner for all the fractures. This case report is about the unusual presentation of multiple fractures involving all the three ipsilateral major joints of the upper limb in an adult following a fall from a height and highlights the uniqueness of the fracture's presentation and effective surgical management for better outcomes and rehabilitation.

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Section: Etiopathogenesismentioning

confidence: 99%

“…10 According to the AO classification, fractures type C2-C3 of subjects who undergo surgery 7 days after trauma have a greater risk of developing elbow stiffness; patients must be informed of the possible failure of the procedure and the possible need for reoperation. 11 The evaluation of patients with substantial elbow stiffness, even following well-reduced and stabilized fractures, suggests that the thickening of soft tissues, especially of the capsule, is associated with a reduction in ROM.…”

Section: Etiopathogenesismentioning

confidence: 99%

The stiff elbow: Current concepts

Masci¹,

Cazzato²,

Milano³

et al. 2020

Orthop Rev (Pavia)

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Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay’s classification), anatomical location (Morrey’s classification), or on the degree of severity of rigidity (Vidal’s classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

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Evaluation of risk factors for stiffness after distal humerus plating

Abstract: Patients who had distal humerus fracture should be informed about the risk of elbow stiffness especially in AO type C2-C3 fractures and surgical treatment should be planned without any delay.

Cited by 11 publications

References 30 publications

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Sequence of Fixing Fractures Involving all the Three Major Joints of the Upper Limb: A Case Report

The stiff elbow: Current concepts

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