From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
J Am Acad Orthop Surg. 2021 Feb 15;29(4):e178-e187. doi: 10.5435/JAAOS-D-18-00801.
The ability to predict contracture development after elbow fracture would benefit patients and physicians. This study aimed to identify factors associated with the development of posttraumatic elbow joint contracture.
A retrospective review of elbow fractures (AO/Orthopaedic Trauma Association [OTA] type 13 and 21) treated at one institution between 2011 and 2015 was performed. Data collected included demographics, injury information, treatment, and postoperative elbow range of motion (ROM). Multivariate logistic regression analyses were performed to identify factors associated with contracture development. Notable contracture was defined as an arc of motion less than 100° flexion/extension, which has been associated with reduced ability to perform activities of daily living.
A total of 278 patients at least 1 8 years of age underwent surgical repair of an elbow fracture or fracture-dislocation during the study period and had at least 6 months of postoperative follow-up. Forty-two (15.1%) developed a clinically notable elbow contracture, of whom 29 (69.0%) developed heterotopic ossification (HO). Multivariate analysis of preoperative variables demonstrated that AO/OTA 13-C fracture classification (odds ratio [OR], 13.7, P = 0.025), multiple noncontiguous fractures (OR, 3.7, P = 0.010), and ulnohumeral dislocation at the time of injury (OR, 4.9, P = 0.005) were independently associated with contracture development. At 6 weeks postoperatively, an arc of elbow ROM less than 50° flexion/extension (OR, 23.0, P < 0.0005) and the presence of HO on radiographs (OR, 6.7, P < 0.0005) were found to be independent risk factors for significant elbow stiffness.
Ulnohumeral dislocation, multiple noncontiguous fractures, AO/OTA 13-C fracture classification, limited elbow ROM at 6 weeks postoperatively, and the presence of radiographic HO at 6 weeks postoperatively are associated with contracture development after surgical elbow fracture repair. Patients with these risk factors should receive aggressive physical therapy and be counseled as to the possible development of a contracture requiring surgical intervention.
预测肘部骨折后发生挛缩的能力将使患者和医生受益。本研究旨在确定与创伤后肘关节挛缩发展相关的因素。
对 2011 年至 2015 年期间在一家机构治疗的肘部骨折（AO/骨科创伤协会[OTA] 13 型和 21 型）进行回顾性研究。收集的数据包括人口统计学、损伤信息、治疗和术后肘关节活动范围（ROM）。进行多变量逻辑回归分析以确定与挛缩发展相关的因素。显著挛缩定义为小于 100°屈伸的运动弧，这与日常生活活动能力降低有关。
在研究期间，共有 278 名至少 18 岁的患者接受了肘部骨折或骨折脱位的手术修复，并在术后至少 6 个月接受了随访。42 例（15.1%）出现临床显著的肘部挛缩，其中 29 例（69.0%）发生异位骨化（HO）。术前变量的多变量分析表明，AO/OTA 13-C 骨折分类（优势比[OR]，13.7，P=0.025）、多个不连续骨折（OR，3.7，P=0.010）和受伤时的尺肱脱位（OR，4.9，P=0.005）与挛缩发展独立相关。术后 6 周时，肘部 ROM 小于 50°屈伸（OR，23.0，P<0.0005）和 X 线片上存在 HO（OR，6.7，P<0.0005）被认为是显著肘部僵硬的独立危险因素。
尺肱脱位、多个不连续骨折、AO/OTA 13-C 骨折分类、术后 6 周时肘部 ROM 受限、术后 6 周时 X 线片上存在 HO 与肘部骨折手术后挛缩的发生有关。有这些危险因素的患者应接受积极的物理治疗，并告知他们可能需要手术干预来治疗挛缩。
