Top

International Orthopaedics

Published in:

01-03-2018 | Original Paper

Risk factors for development of severe post-traumatic elbow stiffness

Authors: Wei Zheng, Jiazhi Liu, Jialin Song, Cunyi Fan

Published in: International Orthopaedics | Issue 3/2018

Abstract

Purpose

The purpose of this study was to compare different grades of elbow stiffness and investigate demographic, injury, and treatment factors potentially associated with the development of severe elbow stiffness.

Methods

We performed a retrospective study involving 169 patients with post-traumatic elbow stiffness between June 2014 and June 2016. Patient demographics, injury, and treatment details were reviewed. Patients were classified into three groups according to the elbow motion. Ordinal regression analyses were performed to examine the independent factors.

Results

Patients were classified into: mild (49 patients), moderate (59 patients), and severe (61 patients) groups. Patients with severe stiffness had a significantly worse elbow functional performance. Univariate ordinal regression revealed that severe elbow stiffness was associated with high-energy injury (odds ratio [OR] 4.73), olecranon fracture (OR 1.92), fracture-dislocation (OR 2.28), and open fracture (OR 3.24). Multivariate regression showed that higher-energy injuries were associated with severe stiffness (OR 4.45, p = 0.003).

Conclusions

Elbow stiffness after fracture surgery often results in joint stiffness. Severe stiffness often resulted in more significant functional impairment. Our study suggested that high-energy injuries were associated with the development of severe elbow stiffness.

Rose SH, Melton LJ, Morrey BF, Illstrup DM, Riggs BL (1982) Epidemiologic features of humeral fractures. Clin Orthop Relat Res 168:24–30

Hong CC, Nashi N, Hey HW, Chee YH, Murphy D (2015) Clinically relevant heterotopic ossification after elbow fracture surgery: A risk factors study. Orthop Traumatol Surg Res 101:209–213. https://doi.org/10.1016/j.otsr.2014.10.021 CrossRefPubMed

Bauer AS, Lawson BK, Bliss RL, Dyer GS (2012) Risk factors for posttraumatic heterotopic ossification of the elbow: case-control study. J Hand Surg Am 37:1422–1429.e1-6. https://doi.org/10.1016/j.jhsa.2012.03.013 CrossRefPubMed

Cheung EV, Sarkissian EJ (2015) Complications of elbow trauma. Hand Clin 31:683–691. https://doi.org/10.1016/j.hcl.2015.06.012 CrossRefPubMed

Thompson HC 3rd, Garcia A (1967) Myositis ossificans: aftermath of elbow injuries. Clin Orthop Relat Res 50:129–134CrossRefPubMed

Morrey BF (2005) The posttraumatic stiff elbow. Clin Orthop Relat Res 431:26–35

Foruria AM, Lawrence TM, Augustin S, Morrey BF, Sanchez-Sotelo J (2014) Heterotopic ossification after surgery for distal humeral fractures. Bone Joint J 96-B:1681–1687. https://doi.org/10.1302/0301-620X.96B12.34091 CrossRefPubMed

Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J (2013) Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 95:e66. https://doi.org/10.2106/JBJS.K.01533 CrossRefPubMed

Shukla DR, Pillai G, McAnany S, Hausman M, Parsons BO (2015) Heterotopic ossification formation after fracture-dislocations of the elbow. J Shoulder Elb Surg 24:333–338. https://doi.org/10.1016/j.jse.2014.11.037 CrossRef

10.

Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458CrossRefPubMed

11.

Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW (2014) Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg [Am] 39:1146–1150. https://doi.org/10.1016/j.jhsa.2014.01.041 CrossRef

12.

Morrey BF (2009) The elbow and its disorders, 4th edn. Saunders, Philadelphia

13.

Abrams GD, Bellino MJ, Cheung EV (2012) Risk factors for development of heterotopic ossification of the elbow after fracture fixation. J Shoulder Elb Surg 21:1550–1554. https://doi.org/10.1016/j.jse.2012.05.040 CrossRef

14.

Garland DE (1991) Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults. Clin Orthop Relat Res 263:59–70

15.

Salazar D, Golz A, Israel H, Marra G (2014) Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications. Clin Orthop Relat Res 472:2269–2275. https://doi.org/10.1007/s11999-014-3591-0 CrossRefPubMedPubMedCentral

16.

Wiggers JK, Helmerhorst GT, Brouwer KM, Niekel MC, Nunez F, Ring D (2014) Injury complexity factors predict heterotopic ossification restricting motion after elbow trauma. Clin Orthop Relat Res 472:2162–2167. https://doi.org/10.1007/s11999-013-3304-0 CrossRefPubMed

17.

Dickens JF, Wilson KW, Tintle SM, Heckert R, Gordon WT, D'Alleyrand JC et al (2015) Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures. Injury 46:676–681. https://doi.org/10.1016/j.injury.2015.01.021 CrossRefPubMed

18.

Ahmed SI, Burns TC, Landt C, Hayda R (2013) Heterotopic ossification in high-grade open fractures sustained in combat: risk factors and prevalence. J Orthop Trauma 27:162–169. https://doi.org/10.1097/BOT.0b013e31825cf742 CrossRefPubMed

Title: Risk factors for development of severe post-traumatic elbow stiffness
Authors: Wei Zheng
Jiazhi Liu
Jialin Song
Cunyi Fan
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 3/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3657-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk factors for development of severe post-traumatic elbow stiffness

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty

The antegrade angle-stable locking intramedullary nail for type-C distal femoral fractures: a thirty four case experience

Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip

Safe placement of pedicle screw in lumbar spine with minimum three year follow-up: a case series and technical note

Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol

Multivariate analysis of factors related to radiographic knee osteoarthritis based on the comparison between football players and matched nonsportsmen