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Structural injuries correlate with radiographic signs of instability on MRI after simple elbow dislocations

A multicenter study

Strukturelle Verletzungen korrelieren mit radiologischen Zeichen der Instabilität in der MRT nach einfachen Ellenbogenluxationen

Eine Multizenterstudie

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Abstract

Background

There is a paucity of literature demonstrating which factors are associated with signs of elbow instability on magnetic resonance imaging (MRI) following simple elbow dislocations (SED).

Objectives

This study aimed to evaluate demographic variables and MRI datasets to identify factors associated with elbow instability following SEDs.

Materials and methods

This retrospective multicenter MRI study included patients who had sustained SED and presented within 21 days of trauma. Measurements included ulnohumeral angle, drop sign, and radiocapitellar and ulnohumeral incongruity. The coronoid tip (Regan Morrey type I), lateral collateral ligament (LCL), common extensor origin (CEO), medial collateral ligament (MCL,) and common flexor origin (CFO) were assessed for injuries. Simple and multiple logistic regression analyses were performed to identify factors associated with signs of elbow instability (e.g., ulnohumeral incongruity > 1 mm) on MRI.

Results

A total of 147 patients (68 women, 79 men) with a mean age of 42.9 years (range, 17–85) were included. Of those, 62 patients (42.2%) demonstrated radiocapitellar (> 2 mm) and 36 patients (25.5%) demonstrated ulnohumeral incongruity (> 1 mm); 17 patients (11.6%) had a drop sign (≥ 4 mm). All patients with elbow instability on MRI had injury to the CEO and/or CFO. In multiple logistic regression, an ulnohumeral angle of ≤ 45° (p = 0.005; OR: 4.95), injury to the CEO (p < 0.001; OR: 10.45), CFO (p < 0.001; OR: 8.38), and coronoid tip (p = 0.002; OR: 5.32) were significantly associated with signs of elbow instability on MRI.

Conclusion

Injury to the CEO, CFO, and coronoid tip as well as an ulnohumeral angle of ≤ 45° are associated with signs of elbow instability on MRI following SEDs. If the CEO or CFO is injured, the odds for instability on MRI are increased by a factor of 10 and 8, respectively.

Zusammenfassung

Hintergrund

Wenige Untersuchungen beschäftigen sich mit der Frage, welche Faktoren mit Zeichen der Instabilität in der Magnetresonanztomographie (MRT) nach akuten, einfachen Ellenbogenluxationen vergesellschaftet sind.

Ziel der Arbeit

Ziel der Arbeit war es, demografische Daten und MRT-Datensätze auszuwerten, um Faktoren zu identifizieren, die mit einer Instabilität nach akuten, einfachen Ellenbogenluxationen einhergehen.

Material und Methoden

Patienten, die eine akute, einfache Ellenbogenluxationen erlitten und innerhalb von 21 Tagen mit MRT vorstellig wurden, wurden in diese retrospektive Multizenterstudie eingeschlossen. Der ulnohumerale Winkel, das „drop sign“, radiocapitellare und ulnohumerale Inkongruenz wurden gemessen. Die Koronoidspitze (Regan-Morrey-Typ I), das laterale (LCL) und mediale Kollateralband (MCL) sowie der Extensoren- (CEO) und Flexorenansatz (CFO) wurden auf Verletzungen geprüft. Einfache und multivariate logistische Regression wurden durchgeführt, um zu identifizieren, welche Variablen mit Ellenbogeninstabilität in der MRT (ulnohumerale Inkongruenz > 1 mm) einhergehen.

Ergebnisse

Insgesamt 147 Patienten (68 Frauen, 79 Männer) mit einem Durchschnittsalter von 42,9 Jahren (17–85 Jahre) wurden in die Auswertung einbezogen. Davon zeigten 62 Patienten (42,2 %) radiocapitellare Inkongruenz (> 2 mm), 36 Patienten (25,5 %) zeigten ulnohumerale Inkongruenz (> 1 mm) und 17 Patienten (11,6 %) wiesen ein „drop sign“ (≥ 4 mm) auf. Alle Patienten mit Ellenbogeninstabilität in der MRT hatten Verletzungen des CEO und/oder CFO. Variablen, die sich in der einfachen logistischen Regression als signifikant erwiesen, wurden in ein multivariates logistisches Modell übertragen. Hier blieben ein ulnohumeraler Winkel ≤ 45° (p = 0,005; Odds Ratio, OR: 4,95), Verletzungen des CEO (p < 0,001; OR: 10,45), CFO (p < 0,001; OR: 8,38) und der Koronoidspitze (p = 0,002; OR: 5,32) signifikant mit Zeichen von Ellenbogeninstabilität in der MRT vergesellschaftet.

Schlussfolgerung

Verletzungen des CEO, CFO, der Koronoidspitze und ein ulnohumeraler Winkel von ≤ 45° sind signifikant mit Zeichen von Ellenbogeninstabilität in der MRT nach akuten, einfachen Ellenbogenluxationen vergesellschaftet. Ist der CEO oder CFO verletzt, so erhöht sich das Risiko für Instabilität in der MRT um den Faktor 10 bzw. 8.

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Authors and Affiliations

  1. Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany

    Philip-Christian Nolte M.A.,  Paul-Alfred Grützner &  Marc Schnetzke

  2. Department of Orthopaedics and Trauma Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Dirk Maier &  Ferdinand Christian Wagner

  3. Department for Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany

    Alexander Ellwein &  Rony-Orijit DeyHazra

  4. Department of Shoulder and Elbow Surgery, Sportsmedicine & Traumatology, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany

    Thorsten Guehring

  5. Arcus Clinic Pforzheim, Department for Shoulder and Elbow Surgery, Pforzheim, Germany

    Konstantin Müller

  6. German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany

    Marc Schnetzke

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  1. Philip-Christian Nolte M.A.
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Correspondence to Philip-Christian Nolte M.A..

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Conflict of interest

P.-C. Nolte, D. Maier, F.C. Wagner, A. Ellwein, R.-O. DeyHazra, T. Guehring, K. Müller, P.-A. Grützner, and M. Schnetzke declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee Rhineland-Palatinate, No. 837.084.14[9323-F]) and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Nolte, PC., Maier, D., Wagner, F.C. et al. Structural injuries correlate with radiographic signs of instability on MRI after simple elbow dislocations. Obere Extremität 16, 203–209 (2021). https://doi.org/10.1007/s11678-021-00651-y

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