微钢板重建肱骨外侧髁治疗Bryan-MorreyⅢ型肱骨小头骨折

Micro-plate reconstruction of humeral lateral condyle for Bryan-MorreyⅢcapitellum humeral fractures

目的探索微钢板重建肱骨远端外侧髁治疗Bryan-MorreyⅢ型肱骨小头骨折的效果。方法回顾性分析2016年11月至2022年4月20例Bryan-MorreyⅢ型肱骨小头骨折患者使用微钢板经肘关节外侧入路治疗肱骨小头骨折手术治疗的效果。结果所有20例患者均经过平均周期14个月的长时间随访。术后影像学评估均获得肱骨远端关节面满意复位。末次随访所有患者均获得骨性愈合,无肱骨小头坏死表现。根据Mayo功能评分评估,17例(85.0%)获得优秀、2例(10.0%)良好、1例(5.0%)中等。所有病例均无肘关节不稳或脱位,2例(10.0%)出现有症状异位骨化,所有患者均无神经功能障碍或感染表现。结论微钢板重建外侧髁治疗Bryan-MorreyⅢ型肱骨小头骨折尤其对于Dubberley B型是有效可行的。

Background Capitulum humeral fractures are rare elbow injuries,accounting for less than 1%of elbow fractures and 6%of distal humerus fractures.Due to the frequent underestimation of capitulum humeral fractures on X-rays,non-displaced or osteochondral fractures may go undetected,making them easily missed or misdiagnosed.Open reduction and internal fixation effectively restore articular surface fractures and allow early functional rehabilitation,thereby preventing elbow stiffness and secondary degenerative arthritis.Among internal fixation methods,K-wires may not provide sufficient stability for early functional recovery and may damage the articular cartilage.Buried screws may cause joint pain and exacerbate joint degeneration when exposed,particularly in patients with avascular necrosis or chondrolysis.Plates can provide sufficient stability and be removed after fracture healing to avoid similar problems.However,for Bryan-Morrey Type III capitulum humeral fractures,in which there is the posterior condylar fracture of the capitellum,the loss of anterior screw fixation in the anterior capitellar articular surface poses a challenge for fixation using only a lateral plate.In this regard,the authors use mini plates placed on the posterior and lateral aspects of the distal humerus to achieve adequate fixation of the anterior capitellar articular surface with screws inserted along the coronal fracture line and to address the issue of ineffective fixation of Dubberley Type B posterior capitulum humeral fracture.Objective To explore the effect of micro-plate reconstruction of humeral lateral condyle for treatment of Bryan-MorreyⅢcapitellum humeral fractures.Methods A retrospective analysis was performed on 20 patients with Bryan-Morrey typeⅢcapitellum humeral fractures treated with micro-plate through lateral elbow approach from November 2016 to April 2022.Results All 20 patients were followed for a long time with a mean period of 14 months.Satisfactory reduction of the distal articular surface of the humerus was obtained by postoperative imaging evaluation.Bone healing was achieved in all patients at the last follow-up,and there was no sign of necrosis of the humeral capitellum.According to the Mayo functional score assessment,17 cases(85.0%)were excellent,2 cases(10.0%)were good,and 1 case(5.0%)was moderate.All the patients had no instability or dislocation of the elbow joint,2 patients(10.0%)had symptomatic ectopic ossification,and none had neurological dysfunction or infection.Conclusion Lateral condylar reconstruction with micro-plate is practical and feasible for Bryan-Morrey typeⅢcapitellum humeral fractures,especially for Dubberley type B fractures.