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Journal of Shoulder and Elbow Surgery

Management of Open Elbow Fractures - The Experiences and Outcomes from a UK Major Trauma Centre

Published:November 19, 2021DOI:https://doi.org/10.1016/j.jse.2021.10.029
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      Abstract

      Background & Hypothesis

      Open fractures about the elbow are an infrequent but complex injury with limited existing literature. The aims of the study were to review: the treatment strategies of open elbows fractures, functional outcome and complication rates associated with the injury and correlate the outcome with the topography of fracture.

      Methods

      Patients (n=21) with open elbow fractures injuries over a 2-year period were analyzed. They were assessed regarding the orthoplastic characteristics of their injury as well any other associated injuries. Outcomes were assessed objectively (achievement of bony union, range of movement, infection status, need for further procedures) and subjectively (Oxford Elbow Score, EQ5D, EQ VAS).

      Results

      The commonest grade of open injury was Grade 3 (43%). Associated orthopedic injuries were present in 62% and associated system injuries in 57%. Almost half of the patients were noted to have had a significantly increased presenting mortality risk as per injury severity score assessment. Mean time to first wound débridement was 31 hours. There were no cases of deep or chronic infection. Complete bony union was noted in 85% of patients. 48% of patients required removal of metal work. Sub-group analysis of the cohort by fracture topography (single uniploar elbow bone injury versus multiple elbow bony injuries) demonstrated no significant difference (p>0.05) regarding rate of complication or final Oxford Elbow Score, EQ5D or EQVAS. Patients with injuries that involved the distal humerus had the highest rate for further procedures (p<0.05). The average Oxford Elbow Score, EQ-5D and EQ-VAS for the whole cohort at final follow-up were 37.4, 0.54 and 62.18 respectively.

      Discussion

      Open elbow injuries are usually from high-energy trauma and often combined with other significant injuries. As a result the timelines to elbow surgery were often delayed. However this did not impact the local infection rates nor did it necessitate further surgery, but made achieving all BOAST targets difficult. Chronic infection was not an issue in this cohort. Sub-group analysis indicates open distal humerus fractures carry the highest risk for further procedures. This is most commonly in the form of removal of metal work and fibrolysis. End outcomes for patients with open elbow fractures can be positive, despite the notable presenting ISS. A sub-specialist elbow and orthoplastic approach is advocated whenever possible.

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