Functional Outcomes of Elbow Injuries Managed According to the Wrightington Classification of Elbow Fracture Dislocations
The aim of this study is to review the functional outcomes of patients managed by application of the Wrightington elbow fracture-dislocation classification system and its corresponding management algorithm.
This is a retrospective case-series of all adult patients who were managed according the Wrightington classification. Images were retrospectively reviewed and classified by all investigators. Any disagreement was resolved by discussion. The content validity of the classification was assessed by comparing each subgroup classification with the intraoperative findings. Primary outcome measures were the range of movement (ROM) and Mayo Elbow Performance Score (MEPS). Complications were collected as a secondary outcome.
Sixty patients were managed using the Wrightington classification (32F/28M) with a mean age of 48(19-84). In order of observed frequency 20 cases (33%) were classified as type B+,18(30%) Type C,11(28%) Type B and 7(12%) Type A. There were 3 Type D+ and 1 Type D.
Fifty eight(96.7%) patients completed a minimum of 3 months follow up. Average follow up was 5.7 months (2-18).The average MEPS at final follow up was 93(55-100) and mean ROM of 15 to 131 degrees. Sub-group analysis showed average MEPS of 91(65- 100) in group A, 93(70-100) in group B, 92(55-100) in group B+,94 (65-100) in group C,100 in group D and 90(70-100) in group D+. The average ROM is 10-136 degrees in group A, 22-128 in group B, 17-127 in group B+, 12-134 in group C, 0-130 in group D and 18-131 degrees in group D+. Four patients underwent secondary surgery. All 4 patients had improved outcomes with average MEPS score improvement from 65 to 94.
The Wrightington Classification system facilitates pattern recognition and provides an algorithm for management for these complex injuries. Our results suggest that predictably good outcomes can be achieved by application of surgical algorithms related to this classification.
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