title: Clinical usefulness of proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS): prospective study of 39 cases.
abstract: BACKGROUND
  Complex fracture-dislocations of the proximal ulna and radius represent a challenge even for expert orthopaedic surgeons. A new comprehensive classification, the proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS), was recently proposed. The aim of this study was to analyze the clinical usefulness of this classification in a large series of patients.
  
  
  METHODS
  We studied 38 patients (39 elbows) with a mean age of 56 years. All patients were classified with the PURCCS by use of standard radiography, computed tomography, and intraoperative fluoroscopy. Surgical treatment was performed according to the PURCCS therapeutic algorithm. Patients were followed up for a mean of 23 months. The clinical evaluation was performed with the Mayo Elbow Performance Score and Index (MEPS and MEPI); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the modified American Shoulder and Elbow Surgeons (m-ASES) score.
  
  
  RESULTS
  Each pattern of fracture-dislocation in our series finds its position within the PURCCS. At the last follow-up, the mean MEPS, DASH score, and m-ASES score were 91.2, 14.9, and 83.9, respectively. The mean extension, flexion, pronation, and supination were 19°, 136°, 81°, and 79°, respectively. According to the MEPI, 72%, 20%, and 8% of cases were rated excellent, good, and fair, respectively. Two patients with elbow stiffness underwent a reoperation, with final satisfactory results.
  
  
  CONCLUSIONS
  The PURCCS helps identify the main lesions of each injury pattern; the associated therapeutic algorithm helps select correct surgical strategies. This study showed that the clinical results were satisfactory in the majority of cases, with few major complications and reinterventions. The PURCCS is a comprehensive classification that may contribute to the surgical management of these difficult fracture-dislocations.
  
  
  METHODS
  Level IV, case series, treatment study.
authors.affiliation: Department of Orthopedic Surgery, Sapienza University of Rome, Rome, Italy. Electronic address: giannicola.giuseppe@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannicola
authors.forename: Marco
authors.initials: M
authors.lastname: Scacchi
authors.forename: Federico M
authors.initials: FM
authors.lastname: Sacchetti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cinotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D004204:Joint Dislocations / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011884:Radius / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D011885:Radius Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D016059:Range of Motion, Articular; D014057:Tomography, X-Ray Computed; D014457:Ulna / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014458:Ulna Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Case Series; Elbow; Level IV; Monteggia fracture; Treatment Study; classification; complex elbow instability; fracture-dislocation; proximal ulnar and radial fracture; radial dislocation; transolecranon fractures