Effect of fracture localization on prognosis in elbow around fractures

Introduction and Objective The aim of our study is to determine the prognosis of intra-articular fractures around the elbow according to the anatomical localizations within the joint, fractures below the joint line and above the joint line, and intra-articular fractures around the elbow. The elbow joint is a difficult area to perform surgery due to the complexity of the joint structure.Since the elbow joint is located between the shoulder and the hand and is on the path of neurovascular structures, care must be taken during surgery. Post-traumatic intra-articular fractures of the elbow cause loss of function in work and daily life. There is no study in the literature that determines the prognosis of fractures in this region. We planned to contribute to the literature with our study on this subject and to guide the studies to be conducted on this subject. . Materials and Methods The study was conducted retrospectively on 204 patients who had previously undergone surgery for intra-articular fractures around the elbow at the Dicle University Orthopedics and Traumatology Clinic. The patients were divided into two groups: Group 1 (intra-articular fractures of the distal humerus and underwent surgery) and Group 2 (intra-articular fractures of the radial head, olecranon, radial head fractures and olecranon intra-articular fractures and underwent surgery). In Group 1, 52 of 82 patients were male and 30 were female, and in Group 2, 96 of 122 patients were male and 26 were female. Of these, 82 patients had distal humerus intra-articular fractures, 42 patients had olecranon intra-articular fractures, 50 patients had radial head fractures, and 30 patients had radial head fractures and olecranon fractures. The mean age of Group 1 was 32.41± standard deviation 13.60±2.12. The mean age of Group 2 was 34.26± standard deviation 10.85±1.38. The mean time for surgery after trauma in Group 1 patients was 1.95 days standard deviation±1.16; the mean time for surgery after trauma in Group 2 patients was 1.85 days standard deviation±1.19. There were additional injuries in 20 of the 204 patients included in the study. 10 of the patients with additional injuries had distal humerus intra-articular fractures, 4 had olecranon intra-articular fractures, and 6 had radial head fractures. As additional injuries, 14 patients had abdominal organ injuries, 4 patients had head injuries, and 2 patients had lung injuries. The Mayo Elbow Performance Score (MEPS) and Disabilities of Arm, Shoulder, and Hand (DASH) scores of the patients in both groups were compared. The DASH scale is a 30-question test and there should not be more than 1 unanswered question. The disability/symptom score is calculated with the formula ([n total score/n]-1)x25. In this formula, "n" indicates the number of answered questions. As the DASH score increases, the prognosis worsens. The Mayo elbow performance scoring allows the evaluation of pain, stability, movement, and daily functions. The scoring result is evaluated as very good (> 90), good (75-89), moderate (60-74), and poor (50 >). Results The MEPS mean of 82 patients with above-elbow fractures was measured as 88.7, with a standard deviation of 1.88; the MEPS mean of 122 patients with below-elbow fractures was measured as 74.6, with a standard deviation of 2.42. The DASH score mean of 82 patients with above-elbow fractures was measured as 12.3, with a standard deviation of 2.2; the DASH score mean of 122 patients with below-elbow fractures was measured as 25.7, with a standard deviation of 2.82. The mean MEPS score of 82 patients with distal humerus intra-articular fractures was 88.7, with a standard deviation of 12.08; the mean MEPS score of 50 patients with radial head fractures was 68.6, with a standard deviation of 15.77; the mean MEPS score of 42 patients with olecranon intra-articular fractures was 87.6, with a standard deviation of 12.61; the mean MEPS score of 30 patients with radial head fractures and olecranon intra-articular fractures was measured as 66.6, with a standard deviation of 22.27. The mean DASH score of 82 patients with distal humerus intra-articular fractures was 12.3, with a standard deviation of 14.09; the mean DASH score of 50 patients with radial head fractures was 33, with a standard deviation of 19.2; the mean DASH score of 42 patients with olecranon intra-articular fractures was 12.9, with a standard deviation of 15.51; The mean DASH score of 30 patients with radial head fractures and olecranon intra-articular fractures was measured as 31.5 and the standard deviation was 27.23. The Mann-Whitney U non-parametric test was used to compare the DASH scores of patients with above-elbow and below-elbow fractures. According to the test result, the DASH score of patients with above-elbow fractures was significantly lower than the DASH scores of patients with below-elbow fractures; U = 859, p < 0.05. The Mann-Whitney U non-parametric test was used to compare the MEPS of patients with above-elbow fractures. According to the test result, the MEPS score of patients with above-elbow fractures was significantly higher than the MEPS of patients with below-elbow fractures; U = 722, p < 0.05. Kruskal Wallis non-parametric test was performed to compare the DASH scores of patients with distal humerus intra-articular, radial head and olecranon intra-articular fractures. According to the test result, a significant difference was found between these fracture types; H(2) =16.83, p < 0.05. According to the Games Howell test result, the DASH score of patients with radial head fractures was found to be significantly higher than patients with the other two fractures p < 0.05 Kruskal Wallis non-parametric test was performed to compare the MEPS of patients with distal humerus intra-articular, radial head and olecranon intra-articular fractures. According to the test result, a significant difference was found between these fracture types; H (2) = 22.428, p < 0.05. According to the Games Howell test result, the MEPS of patients with radial head fractures was found to be significantly lower than patients with the other two fractures p < 0.05 Conclusion According to the general results of our study, the prognosis of fractures below the elbow joint line is worse than fractures above the elbow joint line. Among the intra-articular fractures around the elbow joint, the prognosis of the radius head fracture was worse than that of the distal intra-articular fracture of the humerus and the intra-articular fracture of the olecranon, and there was no difference in the prognosis of the distal intra-articular fracture of the humerus and the intra-articular fracture of the olecranon. In the light of these data, we have formed an idea that the prognosis of intra-articular fractures around the elbow, which cause loss of function in work and daily life, is worse than that of sub-elbow fractures and radius head fractures. There are no studies in the literature on the determination of prognosis with fractures of this region. We think that more studies should be done on radius head fractures and sub-elbow fractures, which have a worse prognosis and cause more loss of function in work and daily life in patients. We have contributed to the literature with this study and guided the studies to be carried out on this subject. Keywords: Intra-Articular Fractures Around the Elbow, Prognosis, Surgery, Humerus Distal End Intra-Articular Fracture, Olecranon Intra-Articular Fracture, Radius Head Fracture