LONG-TERM RESULTS OF OPEN AND CLOSED ELBO W FRACTURES

Fractures of the elbow joint are quite rare compared with the total in cidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late func tional outcome. Sixty-four (10.3%) of 622 patients with closed elbow f ractures and 107 (89%) of 119 patients with open elbow fractures under went a physical examination. The mean follow-up time was 8.2 years. Th e functional outcome was recorded by a modified score (0 - max. 15) ac cording to Morrey. Epidemiological data from both groups revealed a gr eater severity and higher degree of injury in open fractures than in c losed fractures. In contrast, both groups presented a comparably good functional result. The most significant factor for poor outcome (score <5) was identified as nerve lesions. Among all nerve lesions in open fractures, 45% resulted in a functional score of <5; in 32% of closed fractures combined with a nerve lesion a similarly poor result was als o noted. A second major factor appeared to be the method of primary th erapy. An external joint transfixation resulted in a score of <5 in 32 % of patients that were treated primarily by transfixation. In cases i nitially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar lo w score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence o f a nerve lesion and the method of primary treatment, which should fac ilitate early mobilization.