gms | German Medical Science

Objective: Arthrosis is a common sequel of elbow trauma due to direct cartilage injury, instability, and articular incongruity. Not much has been published regarding risk factors for arthrosis after elbow injury, especially in the long term. Data from multiple long-term follow-up studies of injured elbows provided us with an opportunity to assess the risk factors for post-traumatic elbow arthrosis.

Methods: During a four year period, physical evaluations and health status data were collected during evaluation of patients at various stages of recovery after a complex elbow trauma as part of multiple prospective and retrospective studies at our institutions in the United States and in the Netherlands. One-hundred-and-fifty-six patients (89 males and 67 females) with a mean age of 41 years fulfilled the inclusion criteria. Patients were evaluated at a median of 13.7 years (range, 2 to 34 years) after injury. Radiographs of the involved elbow were evaluated for arthrosis according to the system of Broberg and Morrey.

Results and conclusions: Eighty of 156 patients (51%) had arthrosis at final evaluation. Significant predictors of arthrosis according to bivariate analysis included type of injury, mechanism, non-operative treatment, duration of follow-up, and country. Multiple logistic regression analysis identified three significant independent predictors of arthrosis: injury type, treatment, and follow-up time.

Factors related to injury severity (injury type) and suboptimal articular reconstruction (non-operative treatment) predict the development of arthrosis after elbow trauma. Probability of arthrosis increases with time for all injury types and is independent of age, gender, arm dominance, and occupation. At equivalent follow-up, distal humerus fractures and injuries to the capitellum/trochlea are associated with the highest rates of arthrosis.