Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures

Dickens, Jonathan; Wilson, Kevin; Tintle, Scott M.; Heckert, Reed; Gordon, Wade T.; D’Alleyrand, Jean-Claude G.; Potter, Benjamin K.

doi:10.1016/j.injury.2015.01.021

Cited by 13 publications

(7 citation statements)

References 39 publications

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“…A large series of 136 combat-related open elbow fractures—a comparable type of injury—was published by Dickens et al. in 2015 [ 4 ]. The authors reported a mean MEPS of 68 (range, 30–100) with an average ulnohumeral arc of motion of 89°.…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes and complications of open elbow dislocations

et al. 2018

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BackgroundThe current study investigated the clinical outcome of open elbow dislocations, focusing on the influence of associated soft tissue and bone injury.Patients and methodsFrom October 2008 to August 2015, 230 patients with elbow dislocations were treated at the study center. Our retrospective study comprised 21 cases of open elbow dislocations. The mean age of patients was 49 years (20–83 years); there were six (29%) female and 15 (71%) male patients. The range of motion (ROM) of the injured and uninjured elbow was measured, and the Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), and Disability of Arm, Shoulder and Hand (DASH) score were assessed. Complications and revision surgeries were recorded. The influence of the severity of soft tissue injury (I°/II° open vs. III° open) and type of dislocation (simple vs. complex) was evaluated.ResultsAfter a 57-month follow-up (range, 24–98 months), the mean DASH score was 20 ± 15, the MEPS was 82 ± 11, and the MWS was 74 ± 22. The ROM of the injured elbow was significantly decreased compared with the uninjured one (arc of ulnohumeral motion: 104° vs. 137°; p = 0.001). Patients with I°/II° open elbow dislocations had a better clinical outcome according to the MEPS (86 ± 11 vs. 76 ± 9; p = 0.045) and a comparable outcome according to the DASH score (19 ± 18 vs. 21 ± 9; p = 0.238). In all, 11 patients (52%) had postoperative complications and 11 patients underwent at least one revision surgery. Complex elbow dislocations had significantly more complications and revision surgeries than simple dislocations (77% vs. 13%; p = 0.008).ConclusionFavorable clinical outcomes can be achieved after treatment of open elbow dislocations. These injuries are prone to neurovascular damage and complex dislocations are linked to high rates of complications and revision surgeries.

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Section: Discussionmentioning

confidence: 99%

Functional outcomes and complications of open elbow dislocations

et al. 2018

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“…They found that, compared with the isolated articular fracture group, the combined fractures group was more likely to occur joint contractures (25% vs 8.3%, p = 0.009) and severe heterotopic ossi cations (80.7% vs 13.6%, p < 0.001). In another study, Dickens et al [34] reported that periarticular fractures on both sides of the elbow, which de ned as bipolar fractures were signi cantly associated with deceased range of elbow motion and worse outcome in patients with open elbow fractures. In any case, the multiple injuries in the ipsilateral upper limb always re ected greater soft tissue injuries and a more serious injury.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospectives study, Zheng et al [35] retrospectively investigated 169 patients with elbow stiffness and noted that the risk of sever elbow stiffness was markedly higher in high-energy trauma group (OR 4.45, p = 0.03). Dickens et al [34] reviewed 136 patients with open elbow fractures and found that high-energy injury was associated with limited range of elbow motion. This is not surprising, given the association between injury mechanism with the degree of osseous and soft tissue damage-that is, the higher the force, the more serious osseous and soft tissue injury and the more likely to develop elbow stiffness.…”

Section: Discussionmentioning

confidence: 99%

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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“…The initial evaluation of a patient with orthopaedic trauma must include a detailed assessment of the soft tissue envelope. The timing and method of fracture fixation are directly influenced by the degree of trauma to the overlying soft tissues and have been shown to have a direct effect on postoperative function [5,8,13,14,17].…”

Section: Historymentioning

confidence: 99%