Residual articular incongruity is not a predictor of poor functional outcomes in operatively treated intra-articular elbow fractures

Background

Intra-articular and comminuted elbow fractures are complex injuries that present a tremendous surgical challenge. The goal of surgical fracture reduction is an anatomical restoration of the articular surface to restore physiological biomechanics of the elbow joint and to regain an unrestricted elbow function. However, these fractures are often accompanied by residual articular step-off, gap displacement, and intra-articular loose bodies. To date, the potential correlation between the quality of fracture reduction and the postoperative functional outcomes has not been investigated for intra-articular elbow fractures.

Methods

In this retrospective, monocentric study, the postoperative computed tomography–scans of 69 patients undergoing surgical reduction of an intra-articular elbow fracture were analyzed. The quality of fracture reduction was analyzed in the coronal, sagittal, and axial computed tomography–reconstructions based on the following criteria of articular incongruity: articular step-off, gap in the joint surface, and presence of any loose bodies within the elbow joint. The Disabilities of the Arm, Shoulder, and Hand score and Oxford Elbow Score were assessed in a prospective follow-up.

Results

Of 69 patients, 49 (71.0%) met radiological criteria of articular incongruity. Mean articular step-off was 2.27 mm, mean gap displacement was 2.88 mm, and intra-articular loose bodies were present in 15.9% of the cases. For the functional outcomes, mean flexion-extension arc was 98° and mean pronation-supination arc was 156°. At a mean follow-up of 43 months, the median Disabilities of the Arm, Shoulder, and Hand score was 19.0 points and median Oxford Elbow Score was 83.3 points. Stratified by articular congruity, no statistically significant group differences were observed for the postoperative functional outcomes.

Conclusion

In this cohort of operatively treated intra-articular elbow fractures, residual articular incongruity was present in 71% of the cases. However, the postoperative functional outcomes and patient-reported outcome measures were satisfactory. Thus, the present study adds to the notion that residual articular incongruity following intra-articular fractures of the nonweightbearing upper extremity is not associated with inferior clinical and functional outcomes.