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Open elbow fracture sustained in combat complicated by soft tissue, nerve injuries
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CHICAGO – A number of risk factors predict poor outcomes for soldiers who sustained open elbow fractures, including severe soft tissue injuries, nerve injuries, heterotopic ossification, infection and traumatic brain injury, according to a study presented at the American Society for Surgery of the Hand 2012 Meeting.
“Poor outcomes in our series are more likely due to the severity of the soft tissue injury, presence of associated neurovascular injury, heterotopic ossification development, infection and traumatic brain injury,” CPT Jonathan F. Dickens, MD of Walter Reed Army Medical Center in Bethesda, Md., said. “We also know that intraarticular distal humerus fractures in particular are associated with worse outcomes.”
Jonathan F. Dickens
Dickens and researchers reviewed 61 open elbow fractures in 56 patients with a mean age of 25 years from 2004 to 2011 during Operations Iraqi Freedom and Enduring Freedom. They assessed the soldiers for range of motion (ROM), activity status, Injury Severity Score and Mayo Elbow Performance Score. Mean follow-up was 28 months.
The mean Injury Severity Score was 32.2 and the mean Mayo Elbow Performance Score was 67.3. Two-thirds of patients had concomitant nerve deficit (66%), 75% developed heterotopic ossification, 26% had culture-positive deep wound infections, 25% needed a rotational or free tissue transfer and 11% required amputations. In the study, 33% of patients returned to active duty. These risk factors, as well as intraarticular distal humerus fractures, were highly predictive of poor Mayo Elbow Performance scores, he said.
Dickens said the open elbow fractures seen at Walter Reed Army Medical Center have worse outcomes because they are combat-related.
“The worse outcomes in this study of 45% good to excellent [are] clinically different than that reported in open distal humerus fractures, which have on average 70 to 80% good to excellent outcomes in the literature,” he said. “This likely results from the severe soft tissue injury as well as the osseous intraarticular incongruity associated with the blast mechanism of injury in this study.”
Reference:
Dickens J, Wilson KF, Tintle S, et al. Outcomes and risk factors for poor functional outcomes in open elbow fractures. Paper #43. Presented at the American Society for Surgery of the Hand 2012 Meeting. Sept. 6-8. Chicago.
Disclosure: Dickens has no relevant financial disclosures.
