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. 2024 Jan 5:48:102335.
doi: 10.1016/j.jcot.2024.102335. eCollection 2024 Jan.

External fixation about the elbow: Indications and long-term outcomes

Alexa R Deemer  1 , Sara Solasz  1 , Abhishek Ganta  1   2 , Kenneth A Egol  1   2 , Sanjit R Konda  1   2
Affiliations

External fixation about the elbow: Indications and long-term outcomes

Alexa R Deemer et al. J Clin Orthop Trauma. .

Erratum in

Abstract

Background: Operative management is often required for fractures of the elbow, with treatment goals aiming to restore stability, reduction, and early range of motion. The purpose of this study was to determine risk factors for necessitating the application of an external fixator, and to compare range of motion and functional outcomes between patients who required an elbow external fixator to those who did not.

Hypothesis: We hypothesize that patients who require an external fixator will have worse elbow range of motion and functional outcomes when compared to those who did not.

Patients and methods: This is a retrospective study of 391 patients who presented at a Level-I trauma center between March 2011 and January 2021 for operative management of a fracture/fracture-dislocation of the distal humerus (AO/OTA 13A-C) and/or proximal ulna and/or radius (AO/OTA 21A-C). A primary analysis was performed to determine risk factors for necessitating the application of an external fixator. A secondary analysis was performed comparing elbow range-of-motion and functional outcomes between cases and controls.

Results: 391 patients were identified; 26 required external fixation (cases) and 365 did not (controls). Significant risk factors for necessitating placement of an external fixator included large BMI (OR = 1.087, 95 % CI = 1.007-1.173, p = 0.033), elbow dislocation (OR = 7.549, 95 % CI = 2.387-23.870, p = 0.001), open wound status (OR = 9.584, 95 % CI = 2.794-32.878, p < 0.001), and additional non-contiguous orthopaedic injury (OR = 9.225, 95 % CI = 2.219-38.360, p = 0.002). Elbow ROM was poorer in the external fixator group with regards to extension (-15°), flexion (+19.4°), and pronation (+14.3°) (p < 0.05). In addition, those who did not need external fixation had better functional scores (+20.4 points MEPI) (p < 0.05).

Discussion: The use of external fixation about the elbow is associated with significantly worse initial injuries and results in poorer outcomes. These results can be used to inform the surgeon-patient discussion regarding treatment options and expected functional outcomes.

Level of evidence: III.

Keywords: Elbow fracture; External fixation; Outcomes; Trauma; Upper extremity.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
STROBE diagram outlining the recruitment process for patients included in this study.
Fig. 2
Fig. 2
This radiograph demonstrates a lateral view of the left elbow from an adult male patient-seen is an oblique intra-articular fracture of the radial head and neck extending into the proximal radial shaft in near-anatomic alignment.
Fig. 3
Fig. 3
This radiograph demonstrates a lateral view of the left elbow from an adult male patient-seen is a dislocated, comminuted fracture of the proximal ulna.
See this image and copyright information in PMC

References

    1. Egol K.A., Koval K.J., Zuckerman J.D., et al. Wolters Kluwer/Lippincott Williams & Wilkins Health; Philadelphia, PA: 2015. Handbook of Fractures.
    1. Amis A.A., Miller J.H. The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury. 1995 Apr;26(3):163–168. - PubMed
    1. Horrigan P., Braman J.P., Harrison A. Fractures and dislocations about the elbow and their adverse sequelae: contemporary perspectives. Instr Course Lect. 2016;65:41–51. - PubMed
    1. Tan V., Daluiski A., Capo J., Hotchkiss R. Hinged elbow external fixators: indications and uses. J Am Acad Orthop Surg. 2005 Dec;13(8):503–514. doi: 10.5435/00124635-200512000-00003. - DOI - PubMed
    1. Meinberg E.G., Agel J., Roberts C.S., et al. Fracture and dislocation classification compendium- 2018. J Orthop Trauma. 2018;32(Supplement 1):S1–S170. - PubMed

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