Orthotrauma Research Center Amsterdam, Amsterdam, The Netherlands.
Clin Orthop Relat Res. 2014 Jun;472(6):1955-61. doi: 10.1007/s11999-014-3481-5. Epub 2014 Feb 13.
Operative treatment of a displaced, transverse, noncomminuted fracture of the olecranon is associated with good to excellent elbow function in retrospective short-term followup studies. However, to our knowledge, no studies have evaluated objective and subjective outcomes using standardized outcome instruments (ie, DASH and Mayo Elbow Performance Index [MEPI]) to quantify long-term outcome of these specific fractures.
QUESTIONS/PURPOSES: We evaluated (1) factors associated with disability, as measured with the DASH questionnaire; (2) factors associated with ulnohumeral motion; (3) factors associated with pain intensity; and (4) general descriptive findings for posttraumatic arthrosis, MEPI, ulnar neuropathy symptoms, and return to work between 10 and 32 years after open reduction and internal fixation (ORIF) of a transverse, noncomminuted fracture of the olecranon.
Between 1977 and 1997, we performed ORIFs of transverse, noncomminuted olecranon fractures in 109 patients, of whom 35 had died, 14 had incomplete data in our registry, and 19 were lost to followup or declined participation, leaving 41 patients available for followup at a minimum of 10 years after surgery. During that time, our general indication for performing ORIF was greater than 2 mm displacement. The average age of these patients at the time of injury was 35 years (range, 18-73 years). Patient-reported outcome was quantified using the DASH questionnaire, and physician-based outcome was evaluated using the MEPI. To identify factors associated with disability (DASH), impairment (MEPI), ulnohumeral motion, and pain, we examined demographic and clinical data in bivariate analyses, and subsequently significant factors in multivariate analysis to identify independent predictors of outcome.
The sole factor associated with higher DASH scores in multivariable analysis was age at surgery, explaining 20% of the variability, with younger patients performing better. The mean arc of elbow flexion was 142° (range, 110°-160°), and the variation was associated with arthrosis alone (ie, a greater arc of motion was associated with a lesser grade of arthrosis according to the system of Broberg and Morrey). Pain was uncommon and generally was correlated with adverse events.
The good results of operative fixation (tension-band wiring) of a transverse, displaced olecranon fracture are durable with time. Patient-reported outcomes are excellent in the majority of patients. Residual patient-rated disability does not correlate with arthrosis or loss of extension.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
在回顾性短期随访研究中，手术治疗横断、非粉碎性尺骨鹰嘴骨折与良好至极好的肘部功能相关。然而，据我们所知，尚无研究使用标准化的结果评估工具（即 DASH 和 Mayo 肘部功能指数 [MEPI]）来评估这些特定骨折的长期结果，从而评估其客观和主观结果。
问题/目的：我们评估了 (1) 与残疾相关的因素，残疾通过 DASH 问卷进行测量；(2) 与尺肱运动相关的因素；(3) 与疼痛强度相关的因素；以及 (4) 创伤后关节炎、MEPI、尺神经症状以及在切开复位内固定 (ORIF) 治疗横断、非粉碎性尺骨鹰嘴骨折后 10 至 32 年时的重返工作岗位的一般描述性发现。
在 1977 年至 1997 年间，我们对 109 例横断、非粉碎性尺骨鹰嘴骨折患者进行了 ORIF，其中 35 例患者死亡，14 例患者在我们的登记处数据不完整，19 例患者失访或拒绝参与，留下 41 例患者可在手术后至少 10 年进行随访。在此期间，我们进行 ORIF 的一般适应证是大于 2 毫米的移位。这些患者受伤时的平均年龄为 35 岁（范围，18-73 岁）。患者报告的结果使用 DASH 问卷进行量化，医生报告的结果使用 MEPI 进行评估。为了确定与残疾（DASH）、损伤（MEPI）、尺肱运动和疼痛相关的因素，我们在双变量分析中检查了人口统计学和临床数据，然后在多变量分析中检查了显著因素，以确定结果的独立预测因素。
多变量分析中唯一与更高 DASH 评分相关的因素是手术时的年龄，这解释了 20%的变异性，年轻患者表现更好。肘部弯曲的平均弧为 142°（范围，110°-160°），这种变化仅与关节炎有关（即，根据 Broberg 和 Morrey 的系统，更大的运动弧与较轻的关节炎分级相关）。疼痛并不常见，通常与不良事件相关。
经手术固定（张力带钢丝固定）治疗的横断、移位的尺骨鹰嘴骨折的良好结果随时间推移而持久。大多数患者的患者报告结果都很好。残留的患者自评残疾与关节炎或伸展丧失无关。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
