ORIGINAL ARTICLE
The relationship between the clinical symptoms and radiography results of patients with isolated blunt elbow trauma
 
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1
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2
Equally First Author, Mashhad University of Medical Sciences, Mashhad, Iran
Online publish date: 2018-04-20
Publish date: 2018-04-20
 
Electron J Gen Med 2018;15(4):em53
KEYWORDS:
TOPICS:
ABSTRACT:
Introduction:
Elbow injuries are amongst the most common complaints reported by the adults and children referring to the trauma emergency units and they account for 2% to 3% of the referrals to the emergency units. The majority of these patients are referred to radiography for an examination of fracture, whereas about 30% to 40% of these individuals are found having no clear need for radiography in clinical examinations. The present study aims at investigating the relationship between the clinical and fractures’ examinations scales and their usability for predicting the elbow bone injuries in patients with blunt elbow joint trauma.

Patient and Method:
The study sample volume included the entire patients with blunt elbow joint trauma who had referred to Hasheminejad and Imam Reza (Peace be upon him) Hospitals during the time span from 2014 to 2015 and also had no past records of elbow joint fracture, surgery and deformity. After performing a preliminary examination of the patients’ elbow joints which was conducted in the form of extension, supination, pronation, topical tenderness evaluations in such regions as ulnar head, radial head and humerus epicondyle as well as investigation for the existence of ecchymosis and hematoma in the elbow joint region, the patients were subjected to standard lateral and anterior-posterior (AP) radiography; the results of the examinations were recorded in a checklist that had been prepared beforehand. Then, the results of the radiographies were studied based on which the proper treatments were figured out. Afterwards, the results of the radiographies were matched with the preliminary examinations and finally they were all exposed to evaluations so as to come up with a conclusion.

Results:
The study sample volume included 188 patients. Based on the fracture type, the logistic regression analysis data indicated that there is a significant relationship between radial head fracture with restriction in supination of the forearm, sensitivity to palpation on the radius bone head, tenderness to topical touching of the ulnar head bone and sensitivity to topical touch of epicondyle of the humerus and that the former can be applied as a predictor for all of the latter signs (P<0.05). Also, the analyses were indicative of the existence of a significant relationship between the ulnar bone head fracture with pronation and supination limitations, sensitivity to palpation of the ulnar head bone (P<0.05). In distal humerus fractures, the clinical sings are predictable in the form of extension restrictions and tenderness to palpation on the radius head (P<0.05). Logistic regression analysis data were also indicative of a significant relationship between the proximal radial fracture only with supination limitations in elbow joint position (P<0.05) and the combined humerus fractures can be predicted by supination limitations and hematoma in elbow joint (P>0.05). Also, the data analyses showed that there is no significant relationship between the proximal ulnar fracture and any of the clinical signs so the clinical symptoms were found incapable of properly predicting the proximal ulnar fractures (P>0.05).

Conclusion:
Based on the data analysis, it seems that some of the clinical scales can be used as parts of acceptable instruments for predicting the elbow joint fractures so that the unnecessary diagnostic radiographies could be prevented.

 
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