Decoding the Risk of Postoperative Elbow Stiffness: A Predictive Model Integrating Fracture Complexity and Surgical Trauma

Decoding the Risk of Postoperative Elbow Stiffness: A Predictive Model Integrating Fracture Complexity and Surgical Trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Decoding the Risk of Postoperative Elbow Stiffness: A Predictive Model Integrating Fracture Complexity and Surgical Trauma Xinzhe Ma, Shuo Zhang, Jianchao Chen, Shibo Zhai, Luqin Di, Wei Chen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7156772/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Post-traumatic elbow stiffness (PTES) is a prevalent and functionally debilitating complication following surgical treatment of elbow fractures, with an incidence ranging from 10–30%. It significantly compromises upper limb mobility and quality of life, and may result in permanent disability. Despite the identification of multiple risk factors, the etiology of PTES remains multifactorial, and no widely accepted tool exists for early risk stratification. This study aimed to identify independent predictors of PTES and to develop and validate a clinical nomogram for individualized risk prediction. Methods We conducted a retrospective cohort study involving patients who underwent surgical treatment for elbow fractures between January 2021 and December 2024. Functional outcomes were evaluated using range of motion (ROM) and the Mayo Elbow Performance Score (MEPS), and patients were categorized into a non-stiffness group and a stiffness group. The dataset was randomly divided into training and validation cohorts. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, which were then used to construct a predictive nomogram. Model performance was evaluated through discrimination (C-index), calibration (Hosmer–Lemeshow test and calibration plots), and clinical utility (decision curve analysis). Results A total of 376 patients were included, with 264 in the training set and 112 in the validation set. Multivariate logistic regression identified six independent predictors of elbow stiffness: fracture type (OR 11.00), joint dislocation (OR 3.95), mechanism of injury (OR 6.91), surgical approach (OR 4.57), surgical duration (OR 1.01 per minute), and postoperative immobilization time (OR 1.04 per day). The model demonstrated excellent discrimination with a C-index of 0.931 in the training set and 0.821 in the validation set. Calibration curves indicated strong agreement between predicted and observed outcomes. Decision curve analysis showed a favorable net clinical benefit across a wide range of threshold probabilities (10–90%). Conclusion We present a clinically validated prediction model that decodes the multifactorial risk landscape of postoperative elbow stiffness. By integrating fracture complexity and surgical trauma variables, the nomogram offers a practical tool for early risk stratification, enabling personalized rehabilitation planning and improved functional outcomes. elbow fracture joint stiffness predictive model risk factors surgical trauma Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Postoperative elbow stiffness is a common and severe complication following the surgical treatment of elbow fractures, significantly impacting limb function and quality of life. Studies report that approximately 10–30% of patients experience some degree of restricted elbow motion after trauma or surgery, leading to impairment in activities of daily living (ADLs) and personal care [ 1 , 2 ] . Clinically, this stiffness manifests as a reduced range of motion, affecting flexion, extension, pronation, and supination. It involves both mechanical and biological factors, including periarticular soft tissue contracture, capsular fibrosis, heterotopic ossification (HO), and intra-articular adhesions 1,2 . In recent years, with the development of fracture fixation and minimally invasive techniques, the anatomical reduction and stability of elbow fractures have significantly improved. However, the incidence of post-traumatic elbow stiffness (PTES) remains high, especially in patients with complex fractures or high-energy injuries [ 5 ] . Research indicates that the factors influencing postoperative elbow stiffness are complex, encompassing both patient-specific baseline conditions (such as age, muscle strength, metabolic status, alcohol consumption, and smoking) and factors related to the injury and its treatment such as the mechanism of injury, fracture type and location, duration of pre- or postoperative immobilization, multiple surgeries, and the timing and modality of postoperative rehabilitation [ 6 , 7 ] . Among these, prolonged immobilization, poor muscle strength, high-energy trauma, and multiple surgeries have been identified as independent risk factors for stiffness in several large-scale retrospective clinical studies, whereas early and standardized rehabilitation has been shown to effectively reduce its occurrence [ 8 , 9 ] . Furthermore, heterotopic ossification, a key pathological basis for PTES, is highly correlated with local tissue damage, inflammatory responses, fracture type, and multiple surgeries [ 3 , 10 ] . However, existing evidence remains fragmented, and predictive tools with clinical applicability are lacking. In light of this, the present study sought to decode the key clinical and surgical factors driving postoperative elbow stiffness. We performed a comprehensive retrospective analysis to identify independent predictors of PTES and developed a validated clinical nomogram that integrates fracture complexity, surgical trauma, and immobilization parameters. Our goal is to provide a practical, individualized risk assessment tool to support early intervention and optimize rehabilitation strategies, ultimately improving long-term functional outcomes in patients undergoing elbow fracture surgery. Materials and Methods 1. Patient Selection This retrospective study involved the collection and analysis of clinical data from patients with elbow fractures who were treated at the Third Hospital of Hebei Medical University between January 1, 2021, and December 31, 2024. Data were gathered through the medical record query system, outpatient clinic follow-ups, and telephone interviews. The study protocol received approval from the Medical Ethics Committee of the Third Hospital of Hebei Medical University (Ethics Approval Number: 2024-105-1), and informed consent was obtained from all participants. Inclusion criteria: (i) Patients diagnosed with unilateral elbow joint fractures; (ii) Closed elbow joint fractures; (iii) Follow-up period of more than 6 months; (iv) Age > 18 years; (v) The patient was managed with open reduction and internal fixation (ORIF), which resulted in stable fixation, with no evidence of infection either preoperatively or postoperatively. Exclusion criteria: (i) Patients with concomitant craniocerebral injuries; (ii) Fractures accompanied by vascular or nerve injuries; (iii) Pathological fractures, congenital deformities, or other diseases affecting upper limb function; (iv) Chronic fractures; (v) Patients with severe internal diseases of the heart, brain, or lungs rendering them unsuitable for surgical treatment; (vi) Patients with mental disorders who could not effectively cooperate with treatment. 2. Data Collection A standardized data collection form was developed to record the following information: (i) Demographics: gender, age, occupation, body mass index (BMI); (ii) Injury-related factors: season of injury, fracture type, mechanism of injury, preoperative concomitant injuries, presence of preoperative blisters; (iii) Preoperative comorbidities: diabetes, hypertension, coronary heart disease, and other diseases; (iv) Surgical-related factors: time from injury to surgery, surgical method, anesthesia method, use of a tourniquet, surgical approach, incision length, type of internal fixation, intraoperative blood loss, surgery duration, quality of anatomical reduction, postoperative complications, and length of hospital stay; (v) Postoperative follow-up: smoking, alcohol consumption, postoperative immobilization time (time until starting activity after surgery), and whether the patient received rehabilitation treatment at a specialized center. Fracture sites were categorized as distal humeral fractures, radial head fractures, proximal ulnar fractures, or multiple fractures. Multiple fractures included the "terrible triad," proximal radial and ulnar fractures, and distal humeral fractures combined with radial head or proximal ulnar fractures. For fracture classification based on the AO/OTA system, types 13A, 13B, 2R1A, 2R1B, 2U1A, and 2U1B were classified as non-completely intra-articular fractures, while 13C, 2R1C, and 2U1C were classified as completely intra-articular fractures. Surgical approaches were categorized as posterior medial, medial, lateral, or a combined approach; the Kocher, Kaplan, and Boyd approaches were all classified as lateral approaches. Types of internal fixation were categorized as a single fixation method, plate + Kirschner wire, plate + cannulated screw/rivet, Kirschner wire + tension band, cannulated screw + Kirschner wire, Kirschner wire/cannulated screw + rivet, or multiple internal fixation methods. Smoking or drinking was defined as the patient's use of tobacco or alcoholic beverages within 6 months after surgery. Postoperative rehabilitation training was defined as guidance and training received at a specialized rehabilitation institution or a hospital's rehabilitation department after discharge. Postoperative immobilization time was defined as the period during which a sling or static brace was used for fixation. 3. Evaluation Indicators Elbow joint function was assessed using the Mayo Elbow Performance Score (MEPS), with outcomes graded as follows: excellent (≥ 90 points), good (75–89 points), fair (60–74 points), and poor (< 60 points). The excellent and good groups were designated as the non-stiffness group, while the fair and poor groups were designated as the stiffness group. Combined with the range of motion (ROM) of the elbow joint, stiffness was defined as an extension limitation > 30°, flexion angle < 130°, forearm pronation or supination < 50°, or if it affected the patient's daily life or work [ 11 , 12 ] . 4. Statistical Analysis Statistical analysis was performed using R software (version 4.4.3). Normally distributed quantitative data were expressed as mean ± standard deviation (mean ± SD), while non-normally distributed data were presented as median (interquartile range, P50 (P25, P75)). Categorical data were described as counts and percentages (%). Intergroup comparisons were conducted using an independent samples t-test or Mann-Whitney U test (independent samples rank-sum test) and a chi-squared test, with P < 0.05 indicating statistical significance. Independent risk factors identified from the final multivariate analysis were used as predictive factors to establish and validate a clinical prediction model for elbow joint stiffness after fracture surgery. The validation of the model was divided into three parts: discrimination, calibration, and clinical utility, with the first two assessing the model's predictive performance. The main evaluation metric for discrimination is the concordance index (C-index). It is worth noting that in multivariate logistic regression models, the C-index is equivalent to the area under the receiver operating characteristic (ROC) curve (AUC). The C-index ranges from 0.50 to 1.00, where 0.50–0.69 represents low discrimination, 0.70–0.89 represents moderate discrimination, and 0.90-1.00 represents high discrimination [ 13 – 15 ] . Calibration was assessed not only with calibration plots but also with a goodness-of-fit test (Hosmer-Lemeshow test, H-L test). Calibration plots visually demonstrate the agreement between predicted probabilities and actual outcomes. A calibration curve closer to the ideal 45-degree line indicates better model calibration. For the H-L test, a P-value > 0.05 suggests a good fit between the model's predictions and the actual values, also indicating good calibration [ 16 , 17 ] . Clinical utility was assessed using decision curve analysis (DCA). On the DCA graph, the diagonal line represents the net benefit if all patients receive treatment, and the horizontal line represents the net benefit if no patients receive treatment. If the model's DCA curve lies above both of these lines within a specific range of threshold probabilities, it indicates that using the model to guide clinical decisions provides a positive net benefit, thereby demonstrating its clinical effectiveness [ 18 ] . Results 1. Baseline Patient Characteristics A total of 376 patients with elbow fractures were enrolled(Fig. 1 ), with a follow-up duration of 6 to 53 months (Table 1 ). The cohort was divided into a training set (n = 264) and a validation set (n = 112) (Table 2 ). Overall,271 (72.1%) patients achieved good elbow function, while 105 (27.9%) developed elbow stiffness. The incidence of stiffness did not differ significantly between male (63 of 245) and female (42 of 131) patients. The mean patient age was 40.99 ± 15.56 years (range: 18–89 years).The presence of heterotopic ossification was noted in 24 (22.9%) patients in the stiffness group, compared to only 7 (2.6%) patients in the good function group. The distribution of fracture types was as follows: distal humeral (n = 108), radial head (n = 42), proximal ulnar (n = 69), and multiple fractures (n = 157). Table 1 Comparison of Baseline Characteristics Between Patients with Good Elbow Function and Elbow Stiffness Variable Category Total (n = 376) Good Elbow Function (n = 271) Elbow Stiffness (n = 105) P-value Gender Male 245 182 (67.2%) 63 (60.0%) 0.235 Female 131 89 (32.8%) 42 (40.0%) Occupation Student 44 33 (12.2%) 11 (10.5%) 0.083 Farmer 88 59 (21.8%) 29 (27.6%) Worker 52 32 (11.8%) 20 (19.0%) Retired 17 12 (4.4%) 5 (4.8%) Self-employed 15 8 (3.0%) 7 (6.7%) Employee 68 55 (20.3%) 13 (12.4%) Other 92 72 (26.6%) 20 (19.0%) Smoking No 282 200 (73.8%) 82 (78.1%) 0.465 Yes 94 71 (26.2%) 23 (21.9%) Alcohol Consumption No 274 196 (72.3%) 78 (74.3%) 0.799 Yes 102 75 (27.7%) 27 (25.7%) Complications No 262 190 (70.1%) 72 (68.6%) 0.868 Yes 114 81 (29.9%) 33 (31.4%) Hypertension No 323 232 (85.6%) 91 (86.7%) 0.921 Yes 53 39 (14.4%) 14 (13.3%) Diabetes No 350 258 (95.2%) 92 (87.6%) 0.018 * Yes 26 13 (4.8%) 13 (12.4%) Coronary Heart Disease No 371 268 (98.9%) 103 (98.1%) 0.917 Yes 5 3 (1.1%) 2 (1.9%) Fracture Site Distal Humerus Fracture 108 78 (28.8%) 30 (28.6%) < 0.001 * Radial Head Fracture 42 41 (15.1%) 1 (1.0%) Proximal Ulnar Fracture 69 54 (19.9%) 15 (14.3%) Multiple Fractures 157 98 (36.2%) 59 (56.2%) Fracture Type Simple Fracture 245 211 (77.9%) 34 (32.4%) < 0.001 * Complex Fracture 131 60 (22.1%) 71 (67.6%) Dislocation No 252 195 (72.0%) 57 (54.3%) 0.002 * Yes 124 76 (28.0%) 48 (45.7%) Fracture Side Left 186 138 (50.9%) 48 (45.7%) 0.429 Right 190 133 (49.1%) 57 (54.3%) Season of Injury Spring 110 83 (30.6%) 27 (25.7%) 0.543 Summer 118 81 (29.9%) 37 (35.2%) Autumn 85 59 (21.8%) 26 (24.8%) Winter 63 48 (17.7%) 15 (14.3%) Mechanism of Injury Fall 233 180 (66.4%) 53 (50.5%) 0.006 * Traffic Accident 76 44 (16.2%) 32 (30.5%) Fall from Height 36 23 (8.5%) 13 (12.4%) Other 31 24 (8.9%) 7 (6.7%) Preoperative Blisters No 368 267 (98.5%) 101 (96.2%) 0.313 Yes 8 4 (1.5%) 4 (3.8%) Anesthesia Method Brachial plexus & nerve block 76 57 (21.0%) 19 (18.1%) 0.442 General anesthesia (GA) 50 32 (11.8%) 18 (17.1%) Intubated GA + nerve block 49 38 (14.0%) 11 (10.5%) Non-intubated GA + nerve block 201 144 (53.1%) 57 (54.3%) Surgical Approach Posterior midline 146 94 (34.7%) 52 (49.5%) < 0.001 * Combined approach 75 31 (11.4%) 44 (41.9%) Medial approach 35 33 (12.2%) 2 (1.9%) Lateral approach 120 113 (41.7%) 7 (6.7%) Type of Internal Fixation Single fixation method 82 71 (26.2%) 11 (10.5%) < 0.001 * Plate + K-wire 66 56 (20.7%) 10 (9.5%) Plate + cannulated screw/rivet 31 23 (8.5%) 8 (7.6%) K-wire + tension band 26 21 (7.7%) 5 (4.8%) Cannulated screw + K-wire 20 16 (5.9%) 4 (3.8%) K-wire/cannulated screw + rivet 14 13 (4.8%) 1 (1.0%) Multiple fixation methods 137 71 (26.2%) 66 (62.9%) Tourniquet Use No 18 10 (3.7%) 8 (7.6%) 0.183 Yes 358 261 (96.3%) 97 (92.4%) Anatomical Reduction No 64 43 (15.9%) 21 (20.0%) 0.422 Yes 312 228 (84.1%) 84 (80.0%) Heterotopic Ossification No 345 264 (97.4%) 81 (77.1%) < 0.001 * Yes 31 7 (2.6%) 24 (22.9%) Rehabilitation Training No 286 226 (83.4%) 60 (57.1%) < 0.001 * Yes 90 45 (16.6%) 45 (42.9%) Age (years) — 38 37 [29, 53] 41 [31, 55] 0.211 BMI (kg/m²) — 24 24.9 [22.5, 27.4] 24.5 [22.5, 27.7] 0.708 Time from Injury to Surgery (days) — 6 6 [4, 9] 6 [3, 9] 0.718 Incision Length (cm) — 10 10 [7, 14] 12 [10, 15] < 0.001 * Intraoperative Blood Loss (mL) — 153 100 [50, 200] 200 [100, 300] < 0.001 * Surgery Duration (minutes) — 130 120 [90, 159] 174 [130, 200] < 0.001 * Postoperative Immobilization Time (days) — 12 7 [0, 15] 14 [0, 28] < 0.001 * Length of Hospital Stay (days) — 11 10 [8, 14] 13 [10, 17] < 0.001 * *p<0.05. Data are presented as n (%) for categorical variables and median [interquartile range] for continuous variables. Table 2 Comparison of Baseline Characteristics Between the Training and Validation Sets Variable Category Total (n = 376) Training Set (n = 264) Validation Set (n = 112) P-value Elbow Stiffness No 271 191 (72.3%) 80 (71.4%) 0.955 Yes 105 73 (27.7%) 32 (28.6%) Gender Male 245 173 (65.5%) 72 (64.3%) 0.91 Female 131 91 (34.5%) 40 (35.7%) Occupation Student 44 29 (11.0%) 15 (13.4%) 0.571 Farmer 88 62 (23.5%) 26 (23.2%) Worker 52 38 (14.4%) 14 (12.5%) Retired 17 14 (5.3%) 3 (2.7%) Self-employed 15 11 (4.2%) 4 (3.6%) Employee 68 42 (15.9%) 26 (23.2%) Other 92 68 (25.8%) 24 (21.4%) Smoking No 282 196 (74.2%) 86 (76.8%) 0.696 Yes 94 68 (25.8%) 26 (23.2%) Alcohol Consumption No 274 192 (72.7%) 82 (73.2%) 1 Yes 102 72 (27.3%) 30 (26.8%) Complications No 262 182 (68.9%) 80 (71.4%) 0.721 Yes 114 82 (31.1%) 32 (28.6%) Hypertension No 323 227 (86.0%) 96 (85.7%) 1 Yes 53 37 (14.0%) 16 (14.3%) Diabetes No 350 244 (92.4%) 106 (94.6%) 0.58 Yes 26 20 (7.6%) 6 (5.4%) Coronary Heart Disease No 371 261 (98.9%) 110 (98.2%) 0.992 Yes 5 3 (1.1%) 2 (1.8%) Fracture Site Distal Humerus Fracture 108 78 (29.5%) 30 (26.8%) 0.793 Radial Head Fracture 42 31 (11.7%) 11 (9.8%) Proximal Ulnar Fracture 69 49 (18.6%) 20 (17.9%) Multiple Fractures 157 106 (40.2%) 51 (45.5%) Fracture Type Simple Fracture 245 168 (63.6%) 77 (68.8%) 0.405 Complex Fracture 131 96 (36.4%) 35 (31.2%) Dislocation No 252 177 (67.0%) 75 (67.0%) 1 Yes 124 87 (33.0%) 37 (33.0%) Fracture Side Left 186 131 (49.6%) 55 (49.1%) 1 Right 190 133 (50.4%) 57 (50.9%) Season of Injury Spring 110 76 (28.8%) 34 (30.4%) 0.537 Summer 118 81 (30.7%) 37 (33.0%) Autumn 85 65 (24.6%) 20 (17.9%) Winter 63 42 (15.9%) 21 (18.8%) Mechanism of Injury Fall 233 162 (61.4%) 71 (63.4%) 0.905 Traffic Accident 76 54 (20.5%) 22 (19.6%) Fall from Height 36 27 (10.2%) 9 (8.0%) Other 31 21 (8.0%) 10 (8.9%) Preoperative Blisters No 368 257 (97.3%) 111 (99.1%) 0.49 Yes 8 7 (2.7%) 1 (0.9%) Anesthesia Method Brachial plexus & nerve block 76 55 (20.8%) 21 (18.8%) 0.656 General anesthesia (GA) 50 34 (12.9%) 16 (14.3%) Intubated GA + nerve block 49 31 (11.7%) 18 (16.1%) Non-intubated GA + nerve block 201 144 (54.5%) 57 (50.9%) Surgical Approach Posterior midline 146 103 (39.0%) 43 (38.4%) 0.737 Combined approach 75 55 (20.8%) 20 (17.9%) Medial approach 35 22 (8.3%) 13 (11.6%) Lateral approach 120 84 (31.8%) 36 (32.1%) Type of Internal Fixation Single fixation method 82 61 (23.1%) 21 (18.8%) 0.53 Plate + K-wire 66 44 (16.7%) 22 (19.6%) Plate + cannulated screw/rivet 31 23 (8.7%) 8 (7.1%) K-wire + tension band 26 22 (8.3%) 4 (3.6%) Cannulated screw + K-wire 20 13 (4.9%) 7 (6.2%) K-wire/cannulated screw + rivet 14 10 (3.8%) 4 (3.6%) Multiple fixation methods 137 91 (34.5%) 46 (41.1%) Tourniquet Use No 18 14 (5.3%) 4 (3.6%) 0.649 Yes 358 250 (94.7%) 108 (96.4%) Anatomical Reduction No 64 42 (15.9%) 22 (19.6%) 0.465 Yes 312 222 (84.1%) 90 (80.4%) Rehabilitation Training No 286 201 (76.1%) 85 (75.9%) 1 Yes 90 63 (23.9%) 27 (24.1%) Age (years) — — 38 [30, 53] 39.50 [29, 55] 0.858 BMI (kg/m²) — — 24.5 [22.2, 27.4] 25.6 [23.4, 28.1] 0.008 Time from Injury to Surgery (days) — — 6 [4, 9] 6 [4, 9] 0.835 Incision Length (cm) — — 10 [7, 15] 10 [8, 14.25] 0.876 Intraoperative Blood Loss (mL) — — 200 [100, 200] 150 [100, 210] 0.749 Surgery Duration (minutes) — — 130 [95, 180] 127 [100, 180] 0.856 Postoperative Immobilization Time (days) — — 10 [0, 21] 14 [0, 21] 0.726 Length of Hospital Stay (days) — — 11 [8, 15.25] 10.50 [9, 14] 0.406 2. Variable Selection and Model Development 2.1. Univariate Analysis In the univariate analysis, the following factors were found to be significantly associated with functional outcomes of the elbow joint ( P < 0.05): diabetes, fracture site, fracture type, dislocation, mechanism of injury, surgical approach, type of internal fixation, heterotopic ossification, rehabilitation training, incision length, intraoperative blood loss, surgery duration, postoperative immobilization time, and length of hospital stay (Table 1 ). 2.2. Multivariate Analysis To identify independent predictors, variables significant in the univariate analysis ( P < 0.05, Table 1 ) were subjected to a multivariate logistic regression analysis using a backward stepwise elimination procedure. The final model identified six independent risk factors for the development of elbow stiffness: fracture type (OR = 11.00, 95% CI: 4.62–28.82), dislocation (OR = 3.95, 95% CI: 1.63–10.14), mechanism of injury (OR = 6.91, 95% CI: 2.53–20.43), surgical approach (OR = 4.57, 95% CI: 1.80–12.31), surgery duration (OR = 1.01, 95% CI: 1.01–1.02), and postoperative immobilization time (OR = 1.04, 95% CI: 1.01–1.08) (Table 3 ). A predictive nomogram was then constructed based on these six variables, with their respective codings detailed in Table 4 , to provide a visual tool for risk assessment (Fig. 2 ). Table 3 Results of the Multivariate Logistic Regression Analysis Variable B P-value OR 95% CI for OR Lower Diabetes 1.25 0.073 3.48 0.89 Fracture Type 2.4 < 0.001 * 11 4.62 Dislocation 1.37 0.003 * 3.95 1.63 Mechanism of Injury - Traffic Accident 1.93 < 0.001 * 6.91 2.53 Mechanism of Injury - Fall from Height -0.17 0.827 0.84 0.17 Mechanism of Injury - Other 1.57 0.066 4.81 0.83 Surgical Approach - Combined approach 1.52 0.002 * 4.57 1.8 Surgical Approach - Medial approach -1.38 0.254 0.25 0.01 Surgical Approach - Lateral approach -1.88 0.003 * 0.15 0.04 Heterotopic Ossification 1.17 0.1 3.22 0.83 Surgery Duration 0.01 0.001 * 1.01 1.01 Postoperative Immobilization Time 0.04 0.016 * 1.04 1.01 * p<0.05 Table 4 Variable Coding and Reference Groups for Multivariate Logistic Regression Analysis Variable Coding Reference Category Diabetes Categorical (0 = No, 1 = Yes) No Fracture Site Categorical (1 = Distal humerus, 2 = Radial head, 3 = Proximal ulna, 4 = Multiple) Distal humerus fracture Fracture Type Categorical (1 = Simple, 2 = Complex) Simple fracture Dislocation Categorical (0 = No, 1 = Yes) No Mechanism of Injury Categorical (1 = Fall, 2 = Traffic accident, 3 = Fall from height, 4 = Other) Fall Surgical Approach Categorical (1 = Posterior midline, 2 = Combined, 3 = Medial, 4 = Lateral) Posterior midline approach Type of Internal Fixation Categorical (1 = Single method, 2 = Plate + K-wire, 3 = Plate + screw/rivet, 4 = K-wire + tension band, 5 = Screw + K-wire, 6 = K-wire/screw + rivet, 7 = Multiple methods) Single fixation method Rehabilitation Training Categorical (0 = No, 1 = Yes) No Heterotopic Ossification Categorical (0 = No, 1 = Yes) No Incision Length Continuous (cm) — Intraoperative Blood Loss Continuous (mL) — Surgery Duration Continuous (minutes) — Postoperative Immobilization Time Continuous (days) — Length of Hospital Stay Continuous (days) — 3.3 Model Validation 3.1 Discrimination The discriminative ability of the model was assessed using the C-index and ROC curve analysis (Fig. 3 ). The model demonstrated excellent discrimination in the training set with a C-index of 0.931 (95% CI: 0.897–0.965), where an optimal cutoff of 0.226 provided a sensitivity of 0.932 and a specificity of 0.838. In the validation set, the model showed good discrimination with a C-index of 0.821 (95% CI: 0.733–0.909), corresponding to a sensitivity of 0.838 and a specificity of 0.688 at an optimal threshold of 0.385. Overall, these findings confirm the model's robust discriminative power. 3.2 Calibration The model's calibration, which measures the agreement between predicted probabilities and actual outcomes, was evaluated using calibration plots and the Hosmer-Lemeshow (H-L) goodness-of-fit test (Fig. 4 ). The calibration curves for both the training and validation sets closely approximated the ideal 45-degree line, indicating excellent calibration. This was further supported by the non-significant results of the H-L test in both the training set (χ² = 10.238, P = 0.249) and the validation set (χ² = 3.479, P = 0.901), confirming that there was no significant deviation between the predicted risks and the observed frequencies. 3.3 Clinical Utility The DCA curves demonstrated that the prediction model offered a superior net benefit compared to the default strategies of treating all patients or treating none. This benefit was observed over a practical and wide range of threshold probabilities, approximately from 10–90%, confirming the model's potential value and effectiveness in a clinical setting. Discussion Post-traumatic elbow stiffness (PTES) is a common complication in trauma orthopedics, with a reported incidence of 10–30%. With an aging population and an increase in high-energy trauma, the volume of elbow fracture surgeries is rising annually. However, the loss of joint function due to postoperative stiffness continues to severely impact patients' quality of life, sometimes leading to permanent disability [ 19 ] . Despite advancements in fracture fixation and rehabilitation strategies, there remains a critical need for early identification of high-risk patients. In this study, we developed and validated a clinically interpretable nomogram to predict the risk of elbow stiffness by integrating key surgical and injury-related factors. The model demonstrated strong discriminative ability, robust calibration, and practical clinical utility across a wide range of decision thresholds. Our analysis identified six independent predictors of postoperative elbow stiffness: fracture type, dislocation, mechanism of injury, surgical approach, operative duration, and postoperative immobilization time. These findings are consistent with previous literature and further underscore the multifactorial nature of PTES pathogenesis [ 4 , 7 ] . Fracture Complexity and Intra-articular Disruption Fracture type was identified in our study as a strong independent predictor of elbow stiffness (OR 11.00, 95% CI 4.62–28.82), a finding that is highly consistent with numerous reports in the literature. In our study, based on the AO/OTA classification, types 13C, 2R1C, and 2U1C were categorized as complete intra-articular fractures (complex fractures). The fundamental reason complex fractures lead to elbow stiffness is that they not only disrupt the intricate anatomy of the elbow but also trigger a series of biological and mechanical changes that ultimately restrict joint motion [ 20 ] . Firstly, the elbow joint is composed of the humerus, ulna, and radius, a structure that requires high joint surface congruence and intact surrounding soft tissues to ensure normal movement. When injuries such as intra-articular fractures, coronoid fractures, olecranon fractures, or fracture-dislocations occur, they can lead to fracture displacement, comminution, or malunion. This results in an incongruous joint surface and a mechanical misalignment, where the "block effect" of the bone fragments directly limits the flexion and extension of the joint [ 3 , 8 ] . This mechanical obstruction often creates abnormal stress distribution during joint movement, further exacerbating local damage and functional impairment [ 21 ] . Complete intra-articular fractures directly damage the joint surface and cartilage, leading to impaired lubrication (e.g., reduced lubricin) and wear on the articular surface, which in turn triggers an inflammatory response [ 9 ] . The damaged cartilage and underlying sclerotic bone release a large number of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and various interleukins. These cytokines not only promote local inflammation but also stimulate the transformation of fibroblasts into myofibroblasts [ 8 ] . The proliferation of myofibroblasts and the increased expression of alpha-smooth muscle actin (α-SMA) on their surface significantly enhance collagen deposition within the joint capsule, causing it to gradually thicken, harden, and contract, thereby reducing the intra-articular space. Concurrently, direct intra-articular damage can lead to the formation of loose bodies or bone fragments, which may cause mechanical impingement within the joint, leading to pain and resistance during movement [ 22 ] . Secondly, fractures are often accompanied by severe soft tissue injuries, including tears or contusions of the joint capsule, ligaments, tendons, and even the skin. Such injuries cause local hemorrhage, hematoma formation, and an inflammatory response, releasing numerous pro-inflammatory cytokines like IL-1, IL-6, and TNF-α. These activate the proliferation of local fibroblasts and promote their differentiation into contractile myofibroblasts, leading to excessive fibrosis and contracture of the joint capsule and surrounding soft tissues [ 23 ] . This fibrotic process is an intrinsic factor, primarily characterized by capsular thickening and increased collagen deposition, which causes the joint to lose its original elasticity and ultimately form an irreversible contracture. Soft tissue contracture not only limits the gliding and rotation of the elbow joint but can also create abnormal adhesions between tendons, ligaments, and bones, further compounding the loss of motion. Studies have shown abnormal expression of key genes (e.g., SPP1, IBSP, MMP13, and MYO1A) in the damaged joint capsule. These genes are involved in regulating the extracellular matrix and cell cycle control, and their aberrant expression is closely related to the fibrotic process. Furthermore, dysregulation of transcription factors such as TFDP1, KLF9, and KLF1 exacerbates disorders in cell proliferation and differentiation, promoting myofibroblast proliferation and accelerating collagen deposition and capsular hardening. These changes collectively form a self-reinforcing inflammatory-fibrotic loop, leading to a complete loss of the joint's natural cushioning and lubricating functions [ 24 ] . Dislocation In our study, elbow dislocation was an independent risk factor for stiffness. The stability of the elbow joint primarily relies on static bone and ligamentous structures. This makes it susceptible to irreversible structural failure when subjected to high-energy trauma that exceeds the tolerance of these static constraints. A fracture-dislocation is inherently a higher-energy event than a simple dislocation. The immense force is sufficient not only to dislocate the joint but also to fracture the bone, implying more extensive and severe damage. This includes severe tearing of the joint capsule, complete rupture of ligaments, contusion or tearing of surrounding muscles (especially the brachialis muscle anterior to the capsule), and traction injuries to adjacent neurovascular structures. Such fracture-dislocations are often associated with the "terrible triad" of the elbow [ 25 ] . The typical mechanism of injury involves a fall onto an outstretched hand, which generates a complex stress profile that causes the elbow's stabilizers to fail in a characteristic 'lateral-to-medial' progression. The failure sequence begins with the rupture of the lateral collateral ligament (LCL) complex, followed by impact fractures of the radial head and coronoid process as the force transmits through the joint, ultimately culminating in the potential disruption of the medial collateral ligament (MCL). This cascade represents a circumferential and catastrophic failure of the elbow's stability ring, rather than an isolated structural injury [ 26 ] . The fracture of these key osseous stabilizers—the radial head and coronoid process—is a critical event, signifying the loss of the joint's core stability and initiating the subsequent cascade of pathological changes. The coronoid process functions as the primary anterior buttress of the ulnohumeral joint, and its integrity is therefore essential for maintaining a concentric reduction. Consequently, even a small avulsion fracture of the coronoid tip (a Regan-Morrey Type I injury) is often indicative of significant underlying instability [ 27 ] . In contrast, fractures involving more than 50% of the coronoid height (Type II or III) lead to catastrophic instability, rendering the elbow highly susceptible to recurrent dislocation. Thus, surgical repair of the coronoid is considered a cornerstone in reconstructing elbow stability [ 28 ] . Nevertheless, some research indicates that fixation of Type I and II fractures may not be necessary if the radial head and LCL have been definitively repaired [ 29 ] . The radial head is an important secondary stabilizer, but in injuries like the "terrible triad" where the MCL is often compromised, it becomes the primary stabilizer against valgus stress. A fracture of the radial head, especially a comminuted one, effectively removes this critical "lateral buttress," rendering the elbow unstable during both flexion-extension and rotation. Consequently, reliable repair or replacement of the radial head is an almost indispensable component of surgical treatment [ 30 ] . Mechanism of Injury Among injury mechanisms, motor vehicle accidents and falls from height were found to increase the incidence of elbow stiffness. Recent research on injury-related factors shows that complex fractures (e.g., "terrible triad," comminuted intra-articular fractures) resulting from high-energy trauma (e.g., car accidents, falls from height) are more likely to cause stiffness than simple fractures. In their study on the elbow terrible triad, He X et al. also identified high-energy injury as an independent risk factor for postoperative stiffness [ 4 ] . High-energy trauma typically causes direct tearing or contusion of the elbow's surrounding soft tissues, tendons, ligaments, and joint capsule. This damage not only compromises structural integrity but also impairs local blood vessels, nerves, and microcirculation, setting the stage for subsequent inflammatory and reparative processes [ 8 ] . Concurrently, fractures, dislocations, or complex fracture-dislocations exacerbate the destruction of intra-articular structures, leading to an irreversible scarring process in the capsule and surrounding soft tissues. This direct tissue damage and its consequences provide the pathological basis for the inflammatory cascade, cytokine release, and fibrotic tissue proliferation [ 9 ] . Surgical Approach Our study found that the surgical approach is an independent risk factor for elbow stiffness. Different surgical approaches vary in the extent of soft tissue stripping, the degree of muscle retraction, and their impact on the joint capsule. To some extent, the choice of surgical approach also reflects the severity of the fracture and the complexity of the surgery. While a combined medial and lateral approach can provide excellent surgical exposure, it may also lead to more extensive soft tissue trauma, postoperative hematoma, and scar formation, thereby increasing the risk of joint stiffness. This approach requires large incisions on both the medial and lateral sides of the elbow, along with stripping and partial release of the joint capsule and collateral ligaments, which inevitably causes significant local tissue damage [ 9 ] . Extensive soft tissue stripping not only disrupts the original anatomy but can also injure tendons and nerves, interfering with the blood supply and tissue repair capacity of the surgical area [ 3 ] . The necessary tearing and retraction during surgery cause cumulative microtrauma, leading to irreversible cellular and matrix damage and making the postoperative area more susceptible to inflammation and scarring [ 31 ] . Furthermore, repeated manipulation and extensive blunt trauma to the elbow's surrounding structures increase intraoperative hematoma and exudate, providing a material basis for subsequent fibrosis [ 32 ] . Compared to a single approach, a combined medial and lateral approach inherently involves high-intensity manipulation of structures on both sides of the elbow, resulting in a larger trauma zone and a higher likelihood of postoperative instability [ 20 ] . Impaired joint stability not only affects the patient's immediate postoperative mobility but also triggers compensatory mechanisms, promoting further soft tissue contracture and disrupting intra-articular mechanical balance [ 8 ] . This local instability provides a pathological foundation for more severe capsular thickening and surrounding scar formation, thus exacerbating the risk of postoperative functional limitation [ 33 ] . Moreover, extensive soft tissue trauma may cause persistent local pain and inflammation, further hindering patients from engaging in early and effective rehabilitation [ 34 ] . Although few studies have directly identified the surgical approach as an independent risk factor for elbow stiffness, its correlation with the magnitude of surgical trauma is clear. This finding suggests that while ensuring adequate reduction and fixation, the choice of surgical approach should be based on a comprehensive assessment of the fracture type, displacement, and the surgeon's experience. However, when conditions permit, a minimally invasive approach or one with less soft tissue disruption should be prioritized to reduce the risk of postoperative stiffness. Postoperative Immobilization Time This study demonstrates that a prolonged postoperative immobilization time is an independent risk factor for elbow stiffness, which is partially consistent with recent research on the mechanisms of joint stiffness. The duration of postoperative immobilization is a key factor, but its effect and mechanism vary depending on the injury type and patient characteristics. Some research has identified a longer immobilization period (> 2 weeks) as an independent risk factor for stiffness after elbow surgery, which, along with high-energy injury and surgical delay, exacerbates the fibrotic process [ 4 ] . However, in some analyses of outcomes for the terrible triad in adults, a moderately extended immobilization time was reported as a protective factor, possibly related to the need for stability of the intraoperative repair [ 35 ] . This contradiction highlights the "double-edged sword" effect of immobilization duration: short-term immobilization (≤ 2 weeks) can maintain reduction stability, whereas prolonged immobilization induces stiffness by restricting early motion. Recent research indicates that prolonged preoperative fixation (> 2 weeks) is associated with a 1.02-fold increase in the risk of stiffness per week, while postoperative immobilization exceeding 3 weeks significantly impairs functional recovery [ 1 ] . Furthermore, a study on the terrible triad of the elbow reported that patients immobilized for more than 2 weeks postoperatively were over three times more likely to develop elbow stiffness than those who began early mobilization (OR = 3.24, P = 0.023) [ 4 ] . Consistent with these findings, our study also identified postoperative immobilization for more than 2 weeks as an independent risk factor for elbow stiffness. Conversely, shortening the postoperative immobilization period and initiating early functional exercises are evidently beneficial for restoring elbow function and reducing the risk of joint stiffness [ 36 ] . The mechanisms by which prolonged immobilization leads to elbow stiffness may include: (1) Insufficient local mechanical stimulation due to lack of movement promotes the release of inflammatory and pro-fibrotic cytokines, leading to abnormal deposition of collagen and other extracellular matrix components and inducing soft tissue fibrosis [ 37 ] . (2) In a fixed state, the relative sliding between soft tissues is lost, leading to adhesions and structural stiffness as muscle and soft tissues become fibrotic [ 38 ] . (3) Myofibroblasts proliferate excessively due to long-term fixation, and their increased contractility directly causes contraction of the joint capsule and surrounding ligaments [ 37 ] . (4) Persistent inflammation and ischemia impair synovial fluid circulation, reducing nutrient supply to the articular cartilage and thus weakening its function [ 39 ] . (5) A prolonged state of local tissue stress may induce heterotopic ossification, which creates a direct mechanical block to joint motion [ 40 ] . Therefore, the synergistic effect of multiple pathophysiological processes contributes to the close association between prolonged immobilization and elbow stiffness. Clinically, immobilization protocols must be individualized based on injury complexity (e.g., fracture type, ligament repair) and combined with staged rehabilitation to balance the need for stability and mobility. Surgery Duration Surgery duration was another independent risk factor for elbow stiffness identified in this study. A longer surgery time is often associated with the complexity of the fracture, the difficulty of reduction and fixation, intraoperative blood loss, and prolonged exposure of soft tissues. A lengthy surgery not only increases the risk of infection but may also exacerbate postoperative inflammation and edema due to continuous soft tissue retraction and ischemia-reperfusion injury, thereby promoting scar formation. Clinical data show a positive correlation between the length of elbow fracture surgery and the degree of local soft tissue trauma and inflammation [ 4 ] . When surgery is prolonged, repeated manipulations and extended exposure of the operative field significantly increase local trauma. This not only elevates local cell necrosis and the release of inflammatory factors but can also cause abnormalities in the rebuilding of the extracellular matrix, ultimately leading to joint capsule fibrosis [ 41 ] . After soft tissue trauma in elbow surgery, a cascade of glycoproteins, cytokines, and local vascular endothelial factors is released, which can activate fibroblasts and induce their differentiation into myofibroblasts [ 42 ] . A key mediator in this process, TGF-β, is not only central to fibrosis but also plays a critical role in the formation of heterotopic ossification (HO) [ 43 ] . In clinical practice, prolonged surgery time markedly increases the local concentration of these molecules, causing a sustained and excessive inflammatory response that exacerbates postoperative stiffness [ 8 ] . Heterotopic ossification is considered a major cause of postoperative stiffness. Prolonged surgery time leads to both persistent local inflammation and a higher likelihood of hematoma formation, both of which provide an ideal environment for HO development. Once formed, HO gradually calcifies and matures into bone tissue, directly interfering with the joint's normal range of motion and creating an irreversible functional impairment [ 10 ] . Both retrospective and prospective studies have shown that long surgery duration is an independent predictor of postoperative elbow stiffness [ 41 , 42 ] . Through multivariate regression analysis, these studies found a significant association between longer surgery time and the incidence of stiffness even after controlling for other factors, a conclusion supported by both biological rationale and statistical data. Mihas AK et al. found an OR of 4.5 for surgery time greater than 200 minutes, compared to an OR of 5.0 for distal humerus C3-type fractures. This suggests that the additional risk conferred by a long surgery time alone is nearly equivalent to the inherent risk of the most severe fracture type [ 44 ] . Werner BC et al. also linked surgical difficulty and time in their discussion of obesity and complications [ 45 ] . The findings of our study suggest that improving surgical efficiency and minimizing surgery duration, while ensuring the quality of the procedure, is beneficial for reducing postoperative elbow stiffness. Limitations of the Study This study has several limitations that should be acknowledged. First, its single-center, retrospective design inherently carries a risk of selection bias. Consequently, the generalizability of our findings is limited and awaits confirmation from larger, multi-center, prospective studies. Second, the categorization of certain variables, such as fracture type and surgical approach, could be more granular. Future research should aim to quantify these predictors with greater precision. Conclusion In conclusion, this study successfully developed and validated a clinical prediction model for post-traumatic elbow stiffness, identifying fracture type, dislocation, mechanism of injury, combined surgical approach, surgery duration, and postoperative immobilization time as independent risk factors. This model serves as a practical tool to assist clinicians in the early identification of high-risk patients. By providing a scientific basis for targeted preventative and therapeutic strategies, it holds the potential to reduce the incidence of postoperative stiffness and improve long-term functional outcomes. Further external validation and refinement of the model are necessary to maximize its clinical utility. Declarations Authors' contributions XZM: Methodology, Data curation, Software, Writing-original draft; JCC, SBZ and LQD: Investigation; SZ: Data curation,Software; WC: Supervision ;ZYH and LJM: Conceptualization, Supervision, Project administration, Writing - review and editing. All authors read and approved the final manuscript. Availability of data and materials The data are available from the corresponding author upon reason-able request. Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the Third Hospital of Hebei Medical University (Ethics Approval Number: 2024-105-1), and informed consent was obtained from all participants. Funding This study was supported by the Hebei Provincial Government-funded Outstanding Medical Talent Project (Grant No. ZF2024076). Competing interests No conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication. 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Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFAC5oYDEgYMdmzyBxgfMzAcAItJ4NfCCNaSzC/BwGxMtBYwOXMGA5s0UVp02w82HrAosGE2uN1jVl1QcSfa4ADzwds8DHZ5uLSYnUkEOSyNz+DOsbTbM848y91wgC3ZmochuRinlgNgLYeZDQ4kH7vN23YYqIXHTJqHASiOS8v5hyAt/xk3HEhsK+b9B9LC/w2/lhtgWw4AvZ98jJm3AWwLGwEtYFuSk/l5jiVL8xx7ljvzMJux5RyDZDwOSz78WeKPnR0be4/hZ56aO7l9x5sf3nhTYYdTCwgwo0YDM4gwwKMeCBg/4JcfBaNgFIyCkQ4AURdhcjN6NC8AAAAASUVORK5CYII=","orcid":"","institution":"Hebei Medical University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Lijie","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2025-07-18 10:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7156772/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7156772/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88229257,"identity":"39ac9c77-ab19-4422-937b-2adca4d76e49","added_by":"auto","created_at":"2025-08-04 09:11:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":129400,"visible":true,"origin":"","legend":"\u003cp\u003eThe patient screening process\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/3e3b30f586265c30b1032308.png"},{"id":88229256,"identity":"316e5590-f646-4a30-b828-cb3402873e17","added_by":"auto","created_at":"2025-08-04 09:11:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28414,"visible":true,"origin":"","legend":"\u003cp\u003eA clinical nomogram for predicting post-traumatic elbow stiffness\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/dcdef77d75c7ec3bf96e78a1.png"},{"id":88229730,"identity":"3bb6e5b1-40c7-4364-954c-0a6a2c32ce94","added_by":"auto","created_at":"2025-08-04 09:19:57","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":265832,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curves assessing the discrimination of the prediction model in the training (A) and validation (B) sets\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/62d3acf91f97efdb084fa651.jpeg"},{"id":88231163,"identity":"c56d12f0-c835-4ceb-9ee8-3b78464b90e2","added_by":"auto","created_at":"2025-08-04 09:27:57","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":226604,"visible":true,"origin":"","legend":"\u003cp\u003eCalibration of the prediction model. The plots compare the predicted probability of elbow stiffness with the observed frequency of stiffness in the training set (A) and the validation set (B). The diagonal dashed line represents a perfect prediction.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/beeb1f666c52348b8e5f77f3.jpeg"},{"id":88229263,"identity":"d36caa46-68ec-47b7-9e12-6316c5dd88b8","added_by":"auto","created_at":"2025-08-04 09:11:57","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":229928,"visible":true,"origin":"","legend":"\u003cp\u003eDecision curve analysis illustrating the net benefit of the prediction model across a range of threshold probabilities in the training set (A) and validation set (B)\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/cc9125f20f7d1743a285d02d.jpeg"},{"id":99789416,"identity":"b9bde38b-8b70-4b6e-a692-fb73f33dd6b5","added_by":"auto","created_at":"2026-01-08 12:49:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2337885,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7156772/v1/5a917f19-1921-4a03-a00a-f036c0eb01bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Decoding the Risk of Postoperative Elbow Stiffness: A Predictive Model Integrating Fracture Complexity and Surgical Trauma","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostoperative elbow stiffness is a common and severe complication following the surgical treatment of elbow fractures, significantly impacting limb function and quality of life. Studies report that approximately 10\u0026ndash;30% of patients experience some degree of restricted elbow motion after trauma or surgery, leading to impairment in activities of daily living (ADLs) and personal care \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Clinically, this stiffness manifests as a reduced range of motion, affecting flexion, extension, pronation, and supination. It involves both mechanical and biological factors, including periarticular soft tissue contracture, capsular fibrosis, heterotopic ossification (HO), and intra-articular adhesions\u003csup\u003e1,2\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn recent years, with the development of fracture fixation and minimally invasive techniques, the anatomical reduction and stability of elbow fractures have significantly improved. However, the incidence of post-traumatic elbow stiffness (PTES) remains high, especially in patients with complex fractures or high-energy injuries\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Research indicates that the factors influencing postoperative elbow stiffness are complex, encompassing both patient-specific baseline conditions (such as age, muscle strength, metabolic status, alcohol consumption, and smoking) and factors related to the injury and its treatment such as the mechanism of injury, fracture type and location, duration of pre- or postoperative immobilization, multiple surgeries, and the timing and modality of postoperative rehabilitation \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Among these, prolonged immobilization, poor muscle strength, high-energy trauma, and multiple surgeries have been identified as independent risk factors for stiffness in several large-scale retrospective clinical studies, whereas early and standardized rehabilitation has been shown to effectively reduce its occurrence \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Furthermore, heterotopic ossification, a key pathological basis for PTES, is highly correlated with local tissue damage, inflammatory responses, fracture type, and multiple surgeries \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. However, existing evidence remains fragmented, and predictive tools with clinical applicability are lacking.\u003c/p\u003e\u003cp\u003eIn light of this, the present study sought to decode the key clinical and surgical factors driving postoperative elbow stiffness. We performed a comprehensive retrospective analysis to identify independent predictors of PTES and developed a validated clinical nomogram that integrates fracture complexity, surgical trauma, and immobilization parameters. Our goal is to provide a practical, individualized risk assessment tool to support early intervention and optimize rehabilitation strategies, ultimately improving long-term functional outcomes in patients undergoing elbow fracture surgery.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\n\u003ch3\u003e1. Patient Selection\u003c/h3\u003e\n\u003cp\u003eThis retrospective study involved the collection and analysis of clinical data from patients with elbow fractures who were treated at the Third Hospital of Hebei Medical University between January 1, 2021, and December 31, 2024. Data were gathered through the medical record query system, outpatient clinic follow-ups, and telephone interviews. The study protocol received approval from the Medical Ethics Committee of the Third Hospital of Hebei Medical University (Ethics Approval Number: 2024-105-1), and informed consent was obtained from all participants.\u003c/p\u003e\u003cp\u003eInclusion criteria: (i) Patients diagnosed with unilateral elbow joint fractures; (ii) Closed elbow joint fractures; (iii) Follow-up period of more than 6 months; (iv) Age\u0026thinsp;\u0026gt;\u0026thinsp;18 years; (v) The patient was managed with open reduction and internal fixation (ORIF), which resulted in stable fixation, with no evidence of infection either preoperatively or postoperatively.\u003c/p\u003e\u003cp\u003eExclusion criteria: (i) Patients with concomitant craniocerebral injuries; (ii) Fractures accompanied by vascular or nerve injuries; (iii) Pathological fractures, congenital deformities, or other diseases affecting upper limb function; (iv) Chronic fractures; (v) Patients with severe internal diseases of the heart, brain, or lungs rendering them unsuitable for surgical treatment; (vi) Patients with mental disorders who could not effectively cooperate with treatment.\u003c/p\u003e\n\u003ch3\u003e2. Data Collection\u003c/h3\u003e\n\u003cp\u003eA standardized data collection form was developed to record the following information: (i) Demographics: gender, age, occupation, body mass index (BMI); (ii) Injury-related factors: season of injury, fracture type, mechanism of injury, preoperative concomitant injuries, presence of preoperative blisters; (iii) Preoperative comorbidities: diabetes, hypertension, coronary heart disease, and other diseases; (iv) Surgical-related factors: time from injury to surgery, surgical method, anesthesia method, use of a tourniquet, surgical approach, incision length, type of internal fixation, intraoperative blood loss, surgery duration, quality of anatomical reduction, postoperative complications, and length of hospital stay; (v) Postoperative follow-up: smoking, alcohol consumption, postoperative immobilization time (time until starting activity after surgery), and whether the patient received rehabilitation treatment at a specialized center.\u003c/p\u003e\u003cp\u003eFracture sites were categorized as distal humeral fractures, radial head fractures, proximal ulnar fractures, or multiple fractures. Multiple fractures included the \"terrible triad,\" proximal radial and ulnar fractures, and distal humeral fractures combined with radial head or proximal ulnar fractures. For fracture classification based on the AO/OTA system, types 13A, 13B, 2R1A, 2R1B, 2U1A, and 2U1B were classified as non-completely intra-articular fractures, while 13C, 2R1C, and 2U1C were classified as completely intra-articular fractures. Surgical approaches were categorized as posterior medial, medial, lateral, or a combined approach; the Kocher, Kaplan, and Boyd approaches were all classified as lateral approaches. Types of internal fixation were categorized as a single fixation method, plate\u0026thinsp;+\u0026thinsp;Kirschner wire, plate\u0026thinsp;+\u0026thinsp;cannulated screw/rivet, Kirschner wire\u0026thinsp;+\u0026thinsp;tension band, cannulated screw\u0026thinsp;+\u0026thinsp;Kirschner wire, Kirschner wire/cannulated screw\u0026thinsp;+\u0026thinsp;rivet, or multiple internal fixation methods. Smoking or drinking was defined as the patient's use of tobacco or alcoholic beverages within 6 months after surgery. Postoperative rehabilitation training was defined as guidance and training received at a specialized rehabilitation institution or a hospital's rehabilitation department after discharge. Postoperative immobilization time was defined as the period during which a sling or static brace was used for fixation.\u003c/p\u003e\n\u003ch3\u003e3. Evaluation Indicators\u003c/h3\u003e\n\u003cp\u003eElbow joint function was assessed using the Mayo Elbow Performance Score (MEPS), with outcomes graded as follows: excellent (\u0026ge;\u0026thinsp;90 points), good (75\u0026ndash;89 points), fair (60\u0026ndash;74 points), and poor (\u0026lt;\u0026thinsp;60 points). The excellent and good groups were designated as the non-stiffness group, while the fair and poor groups were designated as the stiffness group. Combined with the range of motion (ROM) of the elbow joint, stiffness was defined as an extension limitation\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026deg;, flexion angle\u0026thinsp;\u0026lt;\u0026thinsp;130\u0026deg;, forearm pronation or supination\u0026thinsp;\u0026lt;\u0026thinsp;50\u0026deg;, or if it affected the patient's daily life or work \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e4. Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eStatistical analysis was performed using R software (version 4.4.3). Normally distributed quantitative data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), while non-normally distributed data were presented as median (interquartile range, P50 (P25, P75)). Categorical data were described as counts and percentages (%). Intergroup comparisons were conducted using an independent samples t-test or Mann-Whitney U test (independent samples rank-sum test) and a chi-squared test, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance.\u003c/p\u003e\u003cp\u003eIndependent risk factors identified from the final multivariate analysis were used as predictive factors to establish and validate a clinical prediction model for elbow joint stiffness after fracture surgery. The validation of the model was divided into three parts: discrimination, calibration, and clinical utility, with the first two assessing the model's predictive performance. The main evaluation metric for discrimination is the concordance index (C-index). It is worth noting that in multivariate logistic regression models, the C-index is equivalent to the area under the receiver operating characteristic (ROC) curve (AUC). The C-index ranges from 0.50 to 1.00, where 0.50\u0026ndash;0.69 represents low discrimination, 0.70\u0026ndash;0.89 represents moderate discrimination, and 0.90-1.00 represents high discrimination \u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Calibration was assessed not only with calibration plots but also with a goodness-of-fit test (Hosmer-Lemeshow test, H-L test). Calibration plots visually demonstrate the agreement between predicted probabilities and actual outcomes. A calibration curve closer to the ideal 45-degree line indicates better model calibration. For the H-L test, a P-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05 suggests a good fit between the model's predictions and the actual values, also indicating good calibration \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Clinical utility was assessed using decision curve analysis (DCA). On the DCA graph, the diagonal line represents the net benefit if all patients receive treatment, and the horizontal line represents the net benefit if no patients receive treatment. If the model's DCA curve lies above both of these lines within a specific range of threshold probabilities, it indicates that using the model to guide clinical decisions provides a positive net benefit, thereby demonstrating its clinical effectiveness \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Baseline Patient Characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 376 patients with elbow fractures were enrolled(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with a follow-up duration of 6 to 53 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The cohort was divided into a training set (n\u0026thinsp;=\u0026thinsp;264) and a validation set (n\u0026thinsp;=\u0026thinsp;112) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Overall,271 (72.1%) patients achieved good elbow function, while 105 (27.9%) developed elbow stiffness. The incidence of stiffness did not differ significantly between male (63 of 245) and female (42 of 131) patients. The mean patient age was 40.99\u0026thinsp;\u0026plusmn;\u0026thinsp;15.56 years (range: 18\u0026ndash;89 years).The presence of heterotopic ossification was noted in 24 (22.9%) patients in the stiffness group, compared to only 7 (2.6%) patients in the good function group. The distribution of fracture types was as follows: distal humeral (n\u0026thinsp;=\u0026thinsp;108), radial head (n\u0026thinsp;=\u0026thinsp;42), proximal ulnar (n\u0026thinsp;=\u0026thinsp;69), and multiple fractures (n\u0026thinsp;=\u0026thinsp;157).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Baseline Characteristics Between Patients with Good Elbow Function and Elbow Stiffness\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGood Elbow Function (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eElbow Stiffness (n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182 (67.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89 (32.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.083\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (26.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e200 (73.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82 (78.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e196 (72.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78 (74.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (27.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e190 (70.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (68.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e232 (85.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e91 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e258 (95.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e92 (87.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary Heart Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e268 (98.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103 (98.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistal Humerus Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (28.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRadial Head Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (15.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProximal Ulnar Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (19.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple Fractures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98 (36.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59 (56.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSimple Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e211 (77.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (32.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComplex Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60 (22.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (67.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e195 (72.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (54.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (28.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48 (45.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Side\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e138 (50.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48 (45.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.429\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133 (49.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (54.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeason of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (30.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSummer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (35.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutumn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWinter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (66.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53 (50.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraffic Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (16.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFall from Height\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (8.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (8.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative Blisters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e267 (98.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e101 (96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.313\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnesthesia Method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrachial plexus \u0026amp; nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57 (21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (18.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.442\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral anesthesia (GA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18 (17.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntubated GA\u0026thinsp;+\u0026thinsp;nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (14.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-intubated GA\u0026thinsp;+\u0026thinsp;nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144 (53.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (54.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosterior midline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94 (34.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52 (49.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCombined approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44 (41.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedial approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLateral approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e113 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of Internal Fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle fixation method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlate\u0026thinsp;+\u0026thinsp;K-wire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (9.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlate\u0026thinsp;+\u0026thinsp;cannulated screw/rivet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (8.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK-wire\u0026thinsp;+\u0026thinsp;tension band\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCannulated screw\u0026thinsp;+\u0026thinsp;K-wire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK-wire/cannulated screw\u0026thinsp;+\u0026thinsp;rivet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple fixation methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66 (62.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTourniquet Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (3.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e261 (96.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97 (92.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnatomical Reduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e228 (84.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84 (80.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeterotopic Ossification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e264 (97.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81 (77.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (22.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRehabilitation Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e226 (83.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60 (57.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45 (16.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 [29, 53]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e41 [31, 55]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.9 [22.5, 27.4]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.5 [22.5, 27.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.708\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime from Injury to Surgery (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 [4, 9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 [3, 9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision Length (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 [7, 14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 [10, 15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative Blood Loss (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100 [50, 200]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e200 [100, 300]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery Duration (minutes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120 [90, 159]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e174 [130, 200]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Immobilization Time (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 [0, 15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 [0, 28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of Hospital Stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 [8, 14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 [10, 17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e*p\u0026lt;0.05. Data are presented as n (%) for categorical variables and median [interquartile range] for continuous variables.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Baseline Characteristics Between the Training and Validation Sets\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTraining Set (n\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eValidation Set (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElbow Stiffness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e191 (72.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80 (71.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.955\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73 (27.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e173 (65.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (64.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91 (34.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40 (35.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (11.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (13.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (21.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e196 (74.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86 (76.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.696\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e192 (72.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82 (73.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30 (26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182 (68.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80 (71.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (31.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e227 (86.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (14.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e244 (92.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e106 (94.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary Heart Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e261 (98.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (98.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.992\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistal Humerus Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30 (26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRadial Head Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProximal Ulnar Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple Fractures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106 (40.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e51 (45.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSimple Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168 (63.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77 (68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.405\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComplex Fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96 (36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35 (31.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e177 (67.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (67.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (33.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (33.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Side\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (49.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55 (49.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133 (50.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (50.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeason of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (28.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (30.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSummer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (30.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (33.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutumn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (24.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWinter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (61.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (63.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraffic Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFall from Height\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (8.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative Blisters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e257 (97.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111 (99.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnesthesia Method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrachial plexus \u0026amp; nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral anesthesia (GA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntubated GA\u0026thinsp;+\u0026thinsp;nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-intubated GA\u0026thinsp;+\u0026thinsp;nerve block\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144 (54.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (50.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosterior midline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103 (39.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43 (38.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.737\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCombined approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedial approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLateral approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (31.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of Internal Fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle fixation method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlate\u0026thinsp;+\u0026thinsp;K-wire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlate\u0026thinsp;+\u0026thinsp;cannulated screw/rivet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK-wire\u0026thinsp;+\u0026thinsp;tension band\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCannulated screw\u0026thinsp;+\u0026thinsp;K-wire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (6.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK-wire/cannulated screw\u0026thinsp;+\u0026thinsp;rivet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple fixation methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91 (34.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46 (41.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTourniquet Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.649\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250 (94.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (96.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnatomical Reduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e222 (84.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90 (80.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRehabilitation Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e201 (76.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85 (75.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (23.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 [30, 53]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39.50 [29, 55]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.858\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.5 [22.2, 27.4]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.6 [23.4, 28.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime from Injury to Surgery (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 [4, 9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 [4, 9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision Length (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 [7, 15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 [8, 14.25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.876\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative Blood Loss (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e200 [100, 200]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e150 [100, 210]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.749\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery Duration (minutes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e130 [95, 180]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e127 [100, 180]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Immobilization Time (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 [0, 21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 [0, 21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of Hospital Stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 [8, 15.25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.50 [9, 14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.406\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e2. Variable Selection and Model Development\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Univariate Analysis\u003c/h2\u003e\u003cp\u003eIn the univariate analysis, the following factors were found to be significantly associated with functional outcomes of the elbow joint (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05): diabetes, fracture site, fracture type, dislocation, mechanism of injury, surgical approach, type of internal fixation, heterotopic ossification, rehabilitation training, incision length, intraoperative blood loss, surgery duration, postoperative immobilization time, and length of hospital stay (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Multivariate Analysis\u003c/h2\u003e\u003cp\u003eTo identify independent predictors, variables significant in the univariate analysis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) were subjected to a multivariate logistic regression analysis using a backward stepwise elimination procedure. The final model identified six independent risk factors for the development of elbow stiffness: fracture type (OR\u0026thinsp;=\u0026thinsp;11.00, 95% CI: 4.62\u0026ndash;28.82), dislocation (OR\u0026thinsp;=\u0026thinsp;3.95, 95% CI: 1.63\u0026ndash;10.14), mechanism of injury (OR\u0026thinsp;=\u0026thinsp;6.91, 95% CI: 2.53\u0026ndash;20.43), surgical approach (OR\u0026thinsp;=\u0026thinsp;4.57, 95% CI: 1.80\u0026ndash;12.31), surgery duration (OR\u0026thinsp;=\u0026thinsp;1.01, 95% CI: 1.01\u0026ndash;1.02), and postoperative immobilization time (OR\u0026thinsp;=\u0026thinsp;1.04, 95% CI: 1.01\u0026ndash;1.08) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A predictive nomogram was then constructed based on these six variables, with their respective codings detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, to provide a visual tool for risk assessment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of the Multivariate Logistic Regression Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI for OR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury - Traffic Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury - Fall from Height\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury - Other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach - Combined approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach - Medial approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach - Lateral approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeterotopic Ossification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery Duration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Immobilization Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.016\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u0026lt;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariable Coding and Reference Groups for Multivariate Logistic Regression Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference Category\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (1\u0026thinsp;=\u0026thinsp;Distal humerus, 2\u0026thinsp;=\u0026thinsp;Radial head, 3\u0026thinsp;=\u0026thinsp;Proximal ulna, 4\u0026thinsp;=\u0026thinsp;Multiple)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDistal humerus fracture\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (1\u0026thinsp;=\u0026thinsp;Simple, 2\u0026thinsp;=\u0026thinsp;Complex)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSimple fracture\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of Injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (1\u0026thinsp;=\u0026thinsp;Fall, 2\u0026thinsp;=\u0026thinsp;Traffic accident, 3\u0026thinsp;=\u0026thinsp;Fall from height, 4\u0026thinsp;=\u0026thinsp;Other)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (1\u0026thinsp;=\u0026thinsp;Posterior midline, 2\u0026thinsp;=\u0026thinsp;Combined, 3\u0026thinsp;=\u0026thinsp;Medial, 4\u0026thinsp;=\u0026thinsp;Lateral)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePosterior midline approach\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of Internal Fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (1\u0026thinsp;=\u0026thinsp;Single method, 2\u0026thinsp;=\u0026thinsp;Plate\u0026thinsp;+\u0026thinsp;K-wire, 3\u0026thinsp;=\u0026thinsp;Plate\u0026thinsp;+\u0026thinsp;screw/rivet, 4\u0026thinsp;=\u0026thinsp;K-wire\u0026thinsp;+\u0026thinsp;tension band, 5\u0026thinsp;=\u0026thinsp;Screw\u0026thinsp;+\u0026thinsp;K-wire, 6\u0026thinsp;=\u0026thinsp;K-wire/screw\u0026thinsp;+\u0026thinsp;rivet, 7\u0026thinsp;=\u0026thinsp;Multiple methods)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle fixation method\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRehabilitation Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeterotopic Ossification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategorical (0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision Length\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative Blood Loss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery Duration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous (minutes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative Immobilization Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of Hospital Stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e3.3 Model Validation\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e3.1 Discrimination\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThe discriminative ability of the model was assessed using the C-index and ROC curve analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The model demonstrated excellent discrimination in the training set with a C-index of 0.931 (95% CI: 0.897\u0026ndash;0.965), where an optimal cutoff of 0.226 provided a sensitivity of 0.932 and a specificity of 0.838. In the validation set, the model showed good discrimination with a C-index of 0.821 (95% CI: 0.733\u0026ndash;0.909), corresponding to a sensitivity of 0.838 and a specificity of 0.688 at an optimal threshold of 0.385. Overall, these findings confirm the model's robust discriminative power.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Calibration\u003c/h2\u003e\u003cp\u003eThe model's calibration, which measures the agreement between predicted probabilities and actual outcomes, was evaluated using calibration plots and the Hosmer-Lemeshow (H-L) goodness-of-fit test (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The calibration curves for both the training and validation sets closely approximated the ideal 45-degree line, indicating excellent calibration. This was further supported by the non-significant results of the H-L test in both the training set (χ\u0026sup2; = 10.238, P\u0026thinsp;=\u0026thinsp;0.249) and the validation set (χ\u0026sup2; = 3.479, P\u0026thinsp;=\u0026thinsp;0.901), confirming that there was no significant deviation between the predicted risks and the observed frequencies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Clinical Utility\u003c/h2\u003e\u003cp\u003eThe DCA curves demonstrated that the prediction model offered a superior net benefit compared to the default strategies of treating all patients or treating none. This benefit was observed over a practical and wide range of threshold probabilities, approximately from 10\u0026ndash;90%, confirming the model's potential value and effectiveness in a clinical setting.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePost-traumatic elbow stiffness (PTES) is a common complication in trauma orthopedics, with a reported incidence of 10\u0026ndash;30%. With an aging population and an increase in high-energy trauma, the volume of elbow fracture surgeries is rising annually. However, the loss of joint function due to postoperative stiffness continues to severely impact patients' quality of life, sometimes leading to permanent disability \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Despite advancements in fracture fixation and rehabilitation strategies, there remains a critical need for early identification of high-risk patients. In this study, we developed and validated a clinically interpretable nomogram to predict the risk of elbow stiffness by integrating key surgical and injury-related factors. The model demonstrated strong discriminative ability, robust calibration, and practical clinical utility across a wide range of decision thresholds.\u003c/p\u003e\u003cp\u003eOur analysis identified six independent predictors of postoperative elbow stiffness: fracture type, dislocation, mechanism of injury, surgical approach, operative duration, and postoperative immobilization time. These findings are consistent with previous literature and further underscore the multifactorial nature of PTES pathogenesis\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFracture Complexity and Intra-articular Disruption\u003c/p\u003e\u003cp\u003eFracture type was identified in our study as a strong independent predictor of elbow stiffness (OR 11.00, 95% CI 4.62\u0026ndash;28.82), a finding that is highly consistent with numerous reports in the literature. In our study, based on the AO/OTA classification, types 13C, 2R1C, and 2U1C were categorized as complete intra-articular fractures (complex fractures). The fundamental reason complex fractures lead to elbow stiffness is that they not only disrupt the intricate anatomy of the elbow but also trigger a series of biological and mechanical changes that ultimately restrict joint motion \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFirstly, the elbow joint is composed of the humerus, ulna, and radius, a structure that requires high joint surface congruence and intact surrounding soft tissues to ensure normal movement. When injuries such as intra-articular fractures, coronoid fractures, olecranon fractures, or fracture-dislocations occur, they can lead to fracture displacement, comminution, or malunion. This results in an incongruous joint surface and a mechanical misalignment, where the \"block effect\" of the bone fragments directly limits the flexion and extension of the joint \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. This mechanical obstruction often creates abnormal stress distribution during joint movement, further exacerbating local damage and functional impairment \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eComplete intra-articular fractures directly damage the joint surface and cartilage, leading to impaired lubrication (e.g., reduced lubricin) and wear on the articular surface, which in turn triggers an inflammatory response \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The damaged cartilage and underlying sclerotic bone release a large number of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and various interleukins. These cytokines not only promote local inflammation but also stimulate the transformation of fibroblasts into myofibroblasts \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The proliferation of myofibroblasts and the increased expression of alpha-smooth muscle actin (α-SMA) on their surface significantly enhance collagen deposition within the joint capsule, causing it to gradually thicken, harden, and contract, thereby reducing the intra-articular space. Concurrently, direct intra-articular damage can lead to the formation of loose bodies or bone fragments, which may cause mechanical impingement within the joint, leading to pain and resistance during movement \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSecondly, fractures are often accompanied by severe soft tissue injuries, including tears or contusions of the joint capsule, ligaments, tendons, and even the skin. Such injuries cause local hemorrhage, hematoma formation, and an inflammatory response, releasing numerous pro-inflammatory cytokines like IL-1, IL-6, and TNF-α. These activate the proliferation of local fibroblasts and promote their differentiation into contractile myofibroblasts, leading to excessive fibrosis and contracture of the joint capsule and surrounding soft tissues \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. This fibrotic process is an intrinsic factor, primarily characterized by capsular thickening and increased collagen deposition, which causes the joint to lose its original elasticity and ultimately form an irreversible contracture. Soft tissue contracture not only limits the gliding and rotation of the elbow joint but can also create abnormal adhesions between tendons, ligaments, and bones, further compounding the loss of motion. Studies have shown abnormal expression of key genes (e.g., SPP1, IBSP, MMP13, and MYO1A) in the damaged joint capsule. These genes are involved in regulating the extracellular matrix and cell cycle control, and their aberrant expression is closely related to the fibrotic process. Furthermore, dysregulation of transcription factors such as TFDP1, KLF9, and KLF1 exacerbates disorders in cell proliferation and differentiation, promoting myofibroblast proliferation and accelerating collagen deposition and capsular hardening. These changes collectively form a self-reinforcing inflammatory-fibrotic loop, leading to a complete loss of the joint's natural cushioning and lubricating functions \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003cp\u003eIn our study, elbow dislocation was an independent risk factor for stiffness. The stability of the elbow joint primarily relies on static bone and ligamentous structures. This makes it susceptible to irreversible structural failure when subjected to high-energy trauma that exceeds the tolerance of these static constraints. A fracture-dislocation is inherently a higher-energy event than a simple dislocation. The immense force is sufficient not only to dislocate the joint but also to fracture the bone, implying more extensive and severe damage. This includes severe tearing of the joint capsule, complete rupture of ligaments, contusion or tearing of surrounding muscles (especially the brachialis muscle anterior to the capsule), and traction injuries to adjacent neurovascular structures. Such fracture-dislocations are often associated with the \"terrible triad\" of the elbow \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe typical mechanism of injury involves a fall onto an outstretched hand, which generates a complex stress profile that causes the elbow's stabilizers to fail in a characteristic 'lateral-to-medial' progression. The failure sequence begins with the rupture of the lateral collateral ligament (LCL) complex, followed by impact fractures of the radial head and coronoid process as the force transmits through the joint, ultimately culminating in the potential disruption of the medial collateral ligament (MCL). This cascade represents a circumferential and catastrophic failure of the elbow's stability ring, rather than an isolated structural injury \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The fracture of these key osseous stabilizers\u0026mdash;the radial head and coronoid process\u0026mdash;is a critical event, signifying the loss of the joint's core stability and initiating the subsequent cascade of pathological changes.\u003c/p\u003e\u003cp\u003eThe coronoid process functions as the primary anterior buttress of the ulnohumeral joint, and its integrity is therefore essential for maintaining a concentric reduction. Consequently, even a small avulsion fracture of the coronoid tip (a Regan-Morrey Type I injury) is often indicative of significant underlying instability \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. In contrast, fractures involving more than 50% of the coronoid height (Type II or III) lead to catastrophic instability, rendering the elbow highly susceptible to recurrent dislocation. Thus, surgical repair of the coronoid is considered a cornerstone in reconstructing elbow stability \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, some research indicates that fixation of Type I and II fractures may not be necessary if the radial head and LCL have been definitively repaired \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe radial head is an important secondary stabilizer, but in injuries like the \"terrible triad\" where the MCL is often compromised, it becomes the primary stabilizer against valgus stress. A fracture of the radial head, especially a comminuted one, effectively removes this critical \"lateral buttress,\" rendering the elbow unstable during both flexion-extension and rotation. Consequently, reliable repair or replacement of the radial head is an almost indispensable component of surgical treatment \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMechanism of Injury\u003c/p\u003e\u003cp\u003eAmong injury mechanisms, motor vehicle accidents and falls from height were found to increase the incidence of elbow stiffness. Recent research on injury-related factors shows that complex fractures (e.g., \"terrible triad,\" comminuted intra-articular fractures) resulting from high-energy trauma (e.g., car accidents, falls from height) are more likely to cause stiffness than simple fractures. In their study on the elbow terrible triad, He X et al. also identified high-energy injury as an independent risk factor for postoperative stiffness \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. High-energy trauma typically causes direct tearing or contusion of the elbow's surrounding soft tissues, tendons, ligaments, and joint capsule. This damage not only compromises structural integrity but also impairs local blood vessels, nerves, and microcirculation, setting the stage for subsequent inflammatory and reparative processes \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Concurrently, fractures, dislocations, or complex fracture-dislocations exacerbate the destruction of intra-articular structures, leading to an irreversible scarring process in the capsule and surrounding soft tissues. This direct tissue damage and its consequences provide the pathological basis for the inflammatory cascade, cytokine release, and fibrotic tissue proliferation \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSurgical Approach\u003c/p\u003e\u003cp\u003eOur study found that the surgical approach is an independent risk factor for elbow stiffness. Different surgical approaches vary in the extent of soft tissue stripping, the degree of muscle retraction, and their impact on the joint capsule. To some extent, the choice of surgical approach also reflects the severity of the fracture and the complexity of the surgery. While a combined medial and lateral approach can provide excellent surgical exposure, it may also lead to more extensive soft tissue trauma, postoperative hematoma, and scar formation, thereby increasing the risk of joint stiffness. This approach requires large incisions on both the medial and lateral sides of the elbow, along with stripping and partial release of the joint capsule and collateral ligaments, which inevitably causes significant local tissue damage \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eExtensive soft tissue stripping not only disrupts the original anatomy but can also injure tendons and nerves, interfering with the blood supply and tissue repair capacity of the surgical area \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The necessary tearing and retraction during surgery cause cumulative microtrauma, leading to irreversible cellular and matrix damage and making the postoperative area more susceptible to inflammation and scarring \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Furthermore, repeated manipulation and extensive blunt trauma to the elbow's surrounding structures increase intraoperative hematoma and exudate, providing a material basis for subsequent fibrosis \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCompared to a single approach, a combined medial and lateral approach inherently involves high-intensity manipulation of structures on both sides of the elbow, resulting in a larger trauma zone and a higher likelihood of postoperative instability \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Impaired joint stability not only affects the patient's immediate postoperative mobility but also triggers compensatory mechanisms, promoting further soft tissue contracture and disrupting intra-articular mechanical balance \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. This local instability provides a pathological foundation for more severe capsular thickening and surrounding scar formation, thus exacerbating the risk of postoperative functional limitation \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Moreover, extensive soft tissue trauma may cause persistent local pain and inflammation, further hindering patients from engaging in early and effective rehabilitation \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Although few studies have directly identified the surgical approach as an independent risk factor for elbow stiffness, its correlation with the magnitude of surgical trauma is clear. This finding suggests that while ensuring adequate reduction and fixation, the choice of surgical approach should be based on a comprehensive assessment of the fracture type, displacement, and the surgeon's experience. However, when conditions permit, a minimally invasive approach or one with less soft tissue disruption should be prioritized to reduce the risk of postoperative stiffness.\u003c/p\u003e\u003cp\u003ePostoperative Immobilization Time\u003c/p\u003e\u003cp\u003eThis study demonstrates that a prolonged postoperative immobilization time is an independent risk factor for elbow stiffness, which is partially consistent with recent research on the mechanisms of joint stiffness. The duration of postoperative immobilization is a key factor, but its effect and mechanism vary depending on the injury type and patient characteristics. Some research has identified a longer immobilization period (\u0026gt;\u0026thinsp;2 weeks) as an independent risk factor for stiffness after elbow surgery, which, along with high-energy injury and surgical delay, exacerbates the fibrotic process \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. However, in some analyses of outcomes for the terrible triad in adults, a moderately extended immobilization time was reported as a protective factor, possibly related to the need for stability of the intraoperative repair \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. This contradiction highlights the \"double-edged sword\" effect of immobilization duration: short-term immobilization (\u0026le;\u0026thinsp;2 weeks) can maintain reduction stability, whereas prolonged immobilization induces stiffness by restricting early motion. Recent research indicates that prolonged preoperative fixation (\u0026gt;\u0026thinsp;2 weeks) is associated with a 1.02-fold increase in the risk of stiffness per week, while postoperative immobilization exceeding 3 weeks significantly impairs functional recovery\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Furthermore, a study on the terrible triad of the elbow reported that patients immobilized for more than 2 weeks postoperatively were over three times more likely to develop elbow stiffness than those who began early mobilization (OR\u0026thinsp;=\u0026thinsp;3.24, P\u0026thinsp;=\u0026thinsp;0.023) \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Consistent with these findings, our study also identified postoperative immobilization for more than 2 weeks as an independent risk factor for elbow stiffness. Conversely, shortening the postoperative immobilization period and initiating early functional exercises are evidently beneficial for restoring elbow function and reducing the risk of joint stiffness\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe mechanisms by which prolonged immobilization leads to elbow stiffness may include: (1) Insufficient local mechanical stimulation due to lack of movement promotes the release of inflammatory and pro-fibrotic cytokines, leading to abnormal deposition of collagen and other extracellular matrix components and inducing soft tissue fibrosis \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. (2) In a fixed state, the relative sliding between soft tissues is lost, leading to adhesions and structural stiffness as muscle and soft tissues become fibrotic \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. (3) Myofibroblasts proliferate excessively due to long-term fixation, and their increased contractility directly causes contraction of the joint capsule and surrounding ligaments \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. (4) Persistent inflammation and ischemia impair synovial fluid circulation, reducing nutrient supply to the articular cartilage and thus weakening its function \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. (5) A prolonged state of local tissue stress may induce heterotopic ossification, which creates a direct mechanical block to joint motion \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Therefore, the synergistic effect of multiple pathophysiological processes contributes to the close association between prolonged immobilization and elbow stiffness. Clinically, immobilization protocols must be individualized based on injury complexity (e.g., fracture type, ligament repair) and combined with staged rehabilitation to balance the need for stability and mobility.\u003c/p\u003e\u003cp\u003eSurgery Duration\u003c/p\u003e\u003cp\u003eSurgery duration was another independent risk factor for elbow stiffness identified in this study. A longer surgery time is often associated with the complexity of the fracture, the difficulty of reduction and fixation, intraoperative blood loss, and prolonged exposure of soft tissues. A lengthy surgery not only increases the risk of infection but may also exacerbate postoperative inflammation and edema due to continuous soft tissue retraction and ischemia-reperfusion injury, thereby promoting scar formation.\u003c/p\u003e\u003cp\u003eClinical data show a positive correlation between the length of elbow fracture surgery and the degree of local soft tissue trauma and inflammation \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. When surgery is prolonged, repeated manipulations and extended exposure of the operative field significantly increase local trauma. This not only elevates local cell necrosis and the release of inflammatory factors but can also cause abnormalities in the rebuilding of the extracellular matrix, ultimately leading to joint capsule fibrosis \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. After soft tissue trauma in elbow surgery, a cascade of glycoproteins, cytokines, and local vascular endothelial factors is released, which can activate fibroblasts and induce their differentiation into myofibroblasts \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. A key mediator in this process, TGF-β, is not only central to fibrosis but also plays a critical role in the formation of heterotopic ossification (HO) \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. In clinical practice, prolonged surgery time markedly increases the local concentration of these molecules, causing a sustained and excessive inflammatory response that exacerbates postoperative stiffness \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHeterotopic ossification is considered a major cause of postoperative stiffness. Prolonged surgery time leads to both persistent local inflammation and a higher likelihood of hematoma formation, both of which provide an ideal environment for HO development. Once formed, HO gradually calcifies and matures into bone tissue, directly interfering with the joint's normal range of motion and creating an irreversible functional impairment \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBoth retrospective and prospective studies have shown that long surgery duration is an independent predictor of postoperative elbow stiffness \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Through multivariate regression analysis, these studies found a significant association between longer surgery time and the incidence of stiffness even after controlling for other factors, a conclusion supported by both biological rationale and statistical data. Mihas AK et al. found an OR of 4.5 for surgery time greater than 200 minutes, compared to an OR of 5.0 for distal humerus C3-type fractures. This suggests that the additional risk conferred by a long surgery time alone is nearly equivalent to the inherent risk of the most severe fracture type \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Werner BC et al. also linked surgical difficulty and time in their discussion of obesity and complications \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. The findings of our study suggest that improving surgical efficiency and minimizing surgery duration, while ensuring the quality of the procedure, is beneficial for reducing postoperative elbow stiffness.\u003c/p\u003e\u003cp\u003eLimitations of the Study\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be acknowledged. First, its single-center, retrospective design inherently carries a risk of selection bias. Consequently, the generalizability of our findings is limited and awaits confirmation from larger, multi-center, prospective studies. Second, the categorization of certain variables, such as fracture type and surgical approach, could be more granular. Future research should aim to quantify these predictors with greater precision.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study successfully developed and validated a clinical prediction model for post-traumatic elbow stiffness, identifying fracture type, dislocation, mechanism of injury, combined surgical approach, surgery duration, and postoperative immobilization time as independent risk factors. This model serves as a practical tool to assist clinicians in the early identification of high-risk patients. By providing a scientific basis for targeted preventative and therapeutic strategies, it holds the potential to reduce the incidence of postoperative stiffness and improve long-term functional outcomes. Further external validation and refinement of the model are necessary to maximize its clinical utility.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eXZM: Methodology,\u0026nbsp;Data curation, Software, Writing-original draft;\u0026nbsp;JCC, SBZ and\u0026nbsp;LQD: Investigation;\u0026nbsp;SZ: Data curation,Software;\u0026nbsp;WC:\u0026nbsp;Supervision ;ZYH and\u0026nbsp;LJM: Conceptualization, Supervision, Project administration, Writing - review and editing.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author upon reason-able request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by\u0026nbsp;the Medical Ethics Committee of the Third Hospital of Hebei Medical University (Ethics Approval Number: 2024-105-1), and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Hebei Provincial Government-funded Outstanding Medical Talent Project (Grant No. ZF2024076).\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eNo conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication.\u003c/p\u003e\n\u003cp\u003eDeclaration of AI and AI-assisted technologies in the writing process\u003c/p\u003e\n\u003cp\u003eAI-assisted technologies were used to improve the language and expression during manuscript preparation. All authors have reviewed and take full responsibility for the final content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eQian, Y., Yu, S., Shi, Y., Huang, H., and Fan, C. (2020). Risk factors for the occurrence and progression of posttraumatic elbow stiffness: A case-control study of 688 cases. Front. Med. \u003cem\u003e7\u003c/em\u003e, 604056. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fmed.2020.604056\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2020.604056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng, W., Liu, J., Song, J., and Fan, C. (2018). Risk factors for development of severe post-traumatic elbow stiffness. Int. 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Shoulder Elbow Surg. \u003cem\u003e24\u003c/em\u003e, 1602\u0026ndash;1606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jse.2015.04.019\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2015.04.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"elbow fracture, joint stiffness, predictive model, risk factors, surgical trauma","lastPublishedDoi":"10.21203/rs.3.rs-7156772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7156772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePost-traumatic elbow stiffness (PTES) is a prevalent and functionally debilitating complication following surgical treatment of elbow fractures, with an incidence ranging from 10\u0026ndash;30%. It significantly compromises upper limb mobility and quality of life, and may result in permanent disability. Despite the identification of multiple risk factors, the etiology of PTES remains multifactorial, and no widely accepted tool exists for early risk stratification. This study aimed to identify independent predictors of PTES and to develop and validate a clinical nomogram for individualized risk prediction.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective cohort study involving patients who underwent surgical treatment for elbow fractures between January 2021 and December 2024. Functional outcomes were evaluated using range of motion (ROM) and the Mayo Elbow Performance Score (MEPS), and patients were categorized into a non-stiffness group and a stiffness group. The dataset was randomly divided into training and validation cohorts. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, which were then used to construct a predictive nomogram. Model performance was evaluated through discrimination (C-index), calibration (Hosmer\u0026ndash;Lemeshow test and calibration plots), and clinical utility (decision curve analysis).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 376 patients were included, with 264 in the training set and 112 in the validation set. Multivariate logistic regression identified six independent predictors of elbow stiffness: fracture type (OR 11.00), joint dislocation (OR 3.95), mechanism of injury (OR 6.91), surgical approach (OR 4.57), surgical duration (OR 1.01 per minute), and postoperative immobilization time (OR 1.04 per day). The model demonstrated excellent discrimination with a C-index of 0.931 in the training set and 0.821 in the validation set. Calibration curves indicated strong agreement between predicted and observed outcomes. Decision curve analysis showed a favorable net clinical benefit across a wide range of threshold probabilities (10\u0026ndash;90%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWe present a clinically validated prediction model that decodes the multifactorial risk landscape of postoperative elbow stiffness. By integrating fracture complexity and surgical trauma variables, the nomogram offers a practical tool for early risk stratification, enabling personalized rehabilitation planning and improved functional outcomes.\u003c/p\u003e","manuscriptTitle":"Decoding the Risk of Postoperative Elbow Stiffness: A Predictive Model Integrating Fracture Complexity and Surgical Trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 09:11:53","doi":"10.21203/rs.3.rs-7156772/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff6e7970-6815-4d9e-95ca-32a907e62af5","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T06:39:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 09:11:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7156772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7156772","identity":"rs-7156772","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}