Functional outcome of treatment of elbow fractures in adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: An elbow fracture may occur in one or more of the bones that form the elbow, including the distal humerus, proximal radius and proximal ulna. Fractures of the elbow constitute about 7-10% of all fractures in adults. The most common complication of an elbow fracture is stiffness which reduce function. Although orthopaedic surgeons at Moi Teaching and Referral Hospital (MTRH) frequently manage elbow fractures, their functional outcome is not well documented and hardly any publication exists. Objective: To describe functional outcome of treatment of elbow fractures in adult patients at Moi Teaching and Referral Hospital. Methods: A descriptive prospective study that included adult patients with elbow fractures seen at the casualty, fracture clinic or directly admitted to orthopaedic wards. Informed consent was obtained before enrollment. Consecutive sampling was used. Patients were managed by different surgeons, who decided their treatment options. Interviewer followed patients for functional outcome assessment. Data collection was by interviewer administered questionnaire and Mayo Elbow Performance Index (MEPI) Score tool. The obtained data was analyzed using SPSS, version 21. Approval was granted from Institutional Research Ethics Committee (IREC). Results: There were 47 patients who were recruited, 32 males and 15 females (male/female ratio 2.1:1). Among these, 16 patients (34%) had an olecranon fracture, 15 patients (31.9%) had a distal humerus fracture, 2 patients (4.3%) had a coronoid fracture, 2 patients (4.3%) had a radial head fracture, 1 patient (2.1%) had a combined olecranon and radial head fracture and 11 patients (23.4%) had fracture dislocations. Nine patients (19%) received non-operative treatment and at 6 months their mean MEPI was 76. Thirty-eight patients (81%) received operative treatment and at 6 months their mean MEPI was 85. The average time to surgery was 6.3 days (SD 3.7). Twenty-eight patients were operated before 14 days and 26 patients (93%) had good to excellent results. Ten patients were operated after 14 days and 7 patients (70%) had good to excellent results. Overall Mean MEPI at 6 weeks was 63, at 3 months was 74 and at 6 months was 83 for all elbow fractures after treatment. At 6 months the overall mean MEPI score for patients who started physiotherapy at 3 weeks was 88, at 6 weeks was 77 and at 12 weeks was 73. The observed complications were pain (13 patients), reduced range of motion (11 patients) and infection (2 patients). Conclusions: Overall functional outcome following treatment of elbow fractures at MTRH improved with time and was good. Early operation, before 14 days, and early physiotherapy gave good to excellent functional outcome. The most common complications were elbow pain and stiffness. Recommendations: Elbow fractures that require operative treatment should be operated early to achieve an excellent functional outcome. Physiotherapy should be started early and continued to achieve excellent functional outcome.