Abstract
Purpose and hypothesisAlthough sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL.MethodsThis study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis.ResultsIn total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9–90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site.ConclusionsThe results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.
Highlights
The importance of sex-specific or gender-specific analyses has been pointed out increasingly during the last years [1,2,3,4] such investigations are performed in less than one-third of orthopaedic studies [5]
Taking into account the effects of sex on trauma intensity (p
Influence of sex and trauma impact on ulnar collateral ligament (UCL) ruptures trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site
Summary
The importance of sex-specific (referring to the genotype) or gender-specific (referring to the social constructs overlying the genotype) analyses has been pointed out increasingly during the last years [1,2,3,4] such investigations are performed in less than one-third of orthopaedic studies [5]. Concerning traumatic ligament injuries, sex differences have not been analysed outside the context of anterior cruciate ligament tears [6,7,8,9,10,11]. Within this field, a variety of intrinsic factors responsible for ACL tears have been proposed—such as ligamentous laxity [12, 13], the hormonal effects of oestrogen [14] and anthropometric differences [15] between men and women.
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