Incidence and risk factors for the development of radiographic arthrosis after traumatic elbow injuries.

PURPOSE Radiographic arthrosis is a common sequela of elbow trauma. Few studies have addressed risk factors for radiographic arthrosis after elbow injury, especially in the long term. Data from multiple long-term follow-up studies of patients with surgically treated elbow fractures provided us with an opportunity to assess risk factors for long-term radiographic arthrosis after elbow injury. METHODS During a 5-year period, we obtained radiographs during a research-specific evaluation of 139 patients (81 men and 58 women) 10 or more years (median, 19.5 y; range, 10-34 y) after surgical treatment of an elbow fracture as part of multiple retrospective studies. Radiographic arthrosis was graded according to the system of Broberg and Morrey. Bivariate and multivariable analyses evaluated risk factors for radiographic arthrosis. RESULTS Of 139 patients, 75 had radiographic evidence of arthrosis at final evaluation and 32 had moderate or severe radiographic arthrosis. Mechanism of injury, age, gender, follow-up time, occupation, and limb dominance were not associated with radiographic arthrosis. Multiple logistic regression analysis identified the type of injury as the only independent predictor of moderate to severe radiographic arthrosis. Patients with a bicolumnar fracture of the distal humerus, a capitellum/trochlear fracture, or an elbow fracture-dislocation were 8.0, 7.3, and 5.2 times more likely (odds ratio), respectively, to develop radiographic evidence of moderate or severe radiographic arthrosis than the average patient in this cohort. CONCLUSIONS Distal humerus fractures (both columnar and capitellum/trochlea) and elbow fracture-dislocations are more likely than fractures of the olecranon and radial head to develop moderate or severe radiographic arthrosis in the long term. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.