title: Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures.
abstract: BACKGROUND
  The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures.
  
  
  METHODS
  We performed a retrospective review of 136 combat-related open elbow fractures from 2003 to 2010. Patient demographics, injury characteristics, treatment variables, and complications were recorded. Functional outcomes were analyzed to determine range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Secondary outcome measures included the development of HO, return to duty, and revision operation.
  
  
  RESULTS
  At a median 2.7 years from injury the median MEPS was 67.8 (range 30-100) with an average ulnohumeral arc motion of 89°. Bipolar fractures, with periarticular fractures on both sides of the elbow and at least one side containing intra-articular extension, were independently associated with decreased ulnohumeral motion (p=0.02) and decreased MEPS (p<0.004). Additional independent risk factors for decreased ROM included more severe osseous comminution (p=0.001), and increased time to definitive fixation (p=0.03) and HO (p=0.02). More severe soft tissue injury (Gustilo and Anderson fracture type, p=0.02), peripheral nerve injury (p=0.04), and HO (p=0.03) were independently associated with decreased MEPS. HO developed in 65% (89/136) of extremities and was associated with more severe Orthopaedic Trauma Association (OTA) fracture type (p=0.01) and escalating Gustilo and Anderson fracture classification (p=0.049).
  
  
  CONCLUSIONS
  In the largest series of open elbow fractures, we identified risk factors that portend a poor clinical outcome and decreased ROM. Bipolar elbow fractures, which have not previously been associated with worse results, are particularly prone to decreased ROM and worse outcomes.
  
  
  METHODS
  Prognostic level IV.
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. Electronic address: jon.f.dickens@gmail.com.
authors: Jonathan F
authors: JF
authors: Dickens
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Kevin W
authors: KW
authors: Wilson
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Scott M
authors: SM
authors: Tintle
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Reed
authors: R
authors: Heckert
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Wade T
authors: WT
authors: Gordon
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Jean-Claude G
authors: JC
authors: D'Alleyrand
authors: Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors: Benjamin K
authors: BK
authors: Potter
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005593:Fracture Fixation, Internal; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005597:Fractures, Open / Q000473:pathology / Q000601:surgery*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: Elbow; Open fracture