Lee Ji-Ho, Jenkins Christopher W, Park Gyeong Cheon, Ahn Kee-Baek, Rhyou In Hyeok
Department of Orthopedic Surgery, Pohang SM Christianity Hospital, Pohang, Korea.
Department of Orthopedic Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
Clin Shoulder Elb. 2025 Jun;28(2):187-195. doi: 10.5397/cise.2024.00955. Epub 2025 May 8.
Simple elbow dislocations exhibit residual flexion contracture after long-term immobilization. However, the factors affecting flexion contracture after fixation of distal humerus coronal shear (DHCS) fracture remain unclear.
This study enrolled 21 elbows in DHCS fracture (group A) from 2007 to 2017 and 30 elbows in elbow dislocation (group B) in 2020, all of whom attended a single trauma center. Group A was divided by immobilization period into less than 3 weeks (A1) and more than 3 weeks (A2). Injury patterns of the anterior capsule were divided into proximal stripping, middle displaced, and distal avulsion on magnetic resonance imaging (MRI) scans. Range of motion and functional outcomes were compared between groups A1 and A2.
All patients in group A exhibited proximal stripping of the anterior capsule, while group B showed middle displaced (37%) and distal avulsion (63%) injuries (P<0.001). The mean flexion contracture was 2° in A1 and 8° in A2 (P=0.139), demonstrating no significant difference by immobilization duration. Similarly, the groups had no significant differences in Mayo Elbow Performance Score (MEPS) or Disabilities of the Arm, Shoulder and Hand (DASH) scores.
Flexion contracture following elbow trauma appears to be more closely related to the pattern of anterior capsule injury than the duration of immobilization. Early identification of anterior capsule injury patterns via MRI could inform treatment decisions, particularly in cases where stable surgical fixation is challenging. Prolonged immobilization may be a viable adjuvant treatment option in such cases. Level of evidence: III.
单纯肘关节脱位在长期固定后会出现残留屈曲挛缩。然而，影响肱骨远端冠状面剪切骨折（DHCS）固定后屈曲挛缩的因素仍不清楚。
本研究纳入了2007年至2017年在单一创伤中心就诊的21例DHCS骨折患者的肘关节（A组）和2020年30例肘关节脱位患者的肘关节（B组）。A组根据固定时间分为少于3周（A1）和多于3周（A2）。通过磁共振成像（MRI）扫描将前侧关节囊的损伤模式分为近端剥离、中部移位和远端撕脱。比较A1组和A2组之间的活动范围和功能结果。
A组所有患者均表现为前侧关节囊近端剥离，而B组表现为中部移位（37%）和远端撕脱（63%）损伤（P<0.001）。A1组的平均屈曲挛缩为2°，A2组为8°（P=0.139），固定时间无显著差异。同样，两组在梅奥肘关节功能评分（MEPS）或上肢、肩部和手部功能障碍（DASH）评分方面无显著差异。
肘关节创伤后的屈曲挛缩似乎与前侧关节囊损伤模式的关系比与固定时间的关系更为密切。通过MRI早期识别前侧关节囊损伤模式可为治疗决策提供依据，特别是在稳定手术固定具有挑战性的情况下。在这种情况下，延长固定时间可能是一种可行的辅助治疗选择。证据级别：III级。
