Evaluation of Surgical Treatment of Distal Humeral Fractures in Adults

Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.

Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus:Report of three cases and review of the literature

BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage.Open reduction and internal fixation(ORIF)has become the preferred treatment because it provides anatomical reduction,stable internal fixation,and early motion,but the optimal surgical approach remains controversial.CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach,in which lateral epicondyle osteotomy was performed based on the extended lateral approach.We named the novel surgical approach the lateral epicondyle osteotomy approach.All patients underwent surgical treatment and were discharged successfully.All patients had excellent functional results according to the Mayo elbow performance score.The average range of motion was 118°in flexion/extension and 172°in pronation/supination.Only case 2 had a complication,which was implant prolapse.CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.

Successful Treatment with a Weekly Injection of Teriparatide for the Nonunion of a Distal Humerus Fracture

A distal humerus fracture nonunion is one of the complications with which we should be vigilant. It requires an open reduction and rigid internal fixation. However, treatment with an operative procedure is difficult because the small bones involved in distal humerus fracture nonunion or if osteoporosis is present. And an improvement in the function of the elbow joint is not satisfied because of a postoperative elbow joint contracture. Furthermore, the risk of anesthesia to elderly patients restricts the use of an operation for treatment. A weekly injection of teriparatide has the ability to stimulate bone formation. We present a case of an 87-year-old woman treated with a weekly injection of teriparatide for the nonunion of a distal humerus fracture.

Surgical Treatment of Recent Traumatic Epiphyseal Detachments of the Distal Femur in the Orthopedic and Traumatological Surgery Department of the CHU Bocar Sidy Sall de Kati: About 20 Cases

Introduction: To our knowledge, no scientific study has been conducted at the university hospital of Kati on recent traumatic epiphyseal detachment fractures of the distal femur. However, every day, children present in consultation for knee trauma. Conjugal plate fractures are by definition single to children. Any break in any solution of continuity of this plate is called an epiphyseal fracture or detachment. Objectives: To evaluate the results of surgical treatment of traumatic epiphyseal in detachments of the distal femur recent in children and adolescents. Patients and Method: This was a 13-month prospectively collected longitudinal descriptive study from September 1, 2016 to September 30, 2017. We identified and reviewed 20 medical records of recent traumatic epiphyseal detachments of the distal femur. The parameters studied were sociodemographic, lesion, surgical technique and evolutionary. Results: During the study period, the most affected group age was 12 to 17 years (85%) with an average of 14.65 ± 1.61 years (6 and 20 years). The victims were male (95%). The most frequent etiology was road traffic accident (95%), with a mean time to care of 26.42 ± 10.21 hours and Type II was frequently encountered (85%) with 35% of immediate complications. Cross-bracketing was the most commonly used surgical technique (85%). The result was good (65%). Conclusion: This study allowed us to observe a significant hospital incidence of epiphyseal detachment fractures of the distal femur. Cross pinning was the most commonly used surgical technique with fewer complications (35%) and a satisfactory result in 90% of cases.

Management of distal humeral coronal shear fractures

Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface fol owing distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach(direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.

Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures

Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)approach and olecranon osteotomy(00).At the same time,we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus,and whether it is convenient to convert to the treatment to total elbow arthroplasty(TEA)or 00.Methods:Patients treated with 00 and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed.Inclusion criteria include:(1)patients'age were more than 18 years old,(2)follow-up was no less than 6 months,and(3)patients were diagnosed with type C fractures(based on the AO/OTA classification).Exclusion criteria include:(1)open fractures(Gustillo type 2 or type 3),(2)treated by other approaches,and(3)presented with combined injuries of ipsilateral upper extremities,such as ulnar nerve.Elbow range of motion and triceps extension strength testing were completely valuated,when the fractures had healed.Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up.The data were compared using the two tailed Student's t-test.All data were presented as mean±standard deviation.Results:Eighty-six patients of type C distal humerus fractures,treated by 00 and BTT approach were retrospectively reviewed between July 2014 and December 2017.Fifty-five distal humerus fractures(23 males and 32 females,mean age 52.7 years)treated by BTT approach or 00 were included in this study.There were 10 fractures of type Cl,16 type C2 and 29 type C3 according to the AO/OTA classification.Patients were divided into two surgical approach groups chosen by the operators:BTT group(28 patients)and 00 group(27 patients).And the mean follow-up time of all patients was 15.6 months(range,6-36 months).Three cases in BTT group were converted to TEA,and one converted to 00.Only one case in BTT group presented poor articular reduction with a step more than 2 mm.There were not significantly different in functional outcomes according to the Mayo elbow performance score,operation time and extension flexion motion are values between BTT group and 00 group(p>0.05).Complications and reoperation rate were also similar in the two groups.Triceps manual muscle testing were no significant difference in the two groups,even subdivided in elder patients(aged>60 years old).Conclusion:BTT is a safe approach to achieve similar functional result comparing with 00.BTT were not suitable for every case with severe comminuted pattern,but it avoids the potential complications related to 00,and has no complications concerning with triceps tendon.It is convenient for open reduction internal fixation and flexible to be converted to 00,as well as available to be converted to TEA in elder patients.

Robert Jones bandage versus cast in the treatment of distal radius fracture in children:A randomized controlled trial

Purpose:The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones(RJ)bandage.The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence,child comfortability,and family satisfaction.Methods:The study was a randomized controlled non-inferiority clinical trial including children with recent(less than 5 days)fractures at the distal end of the radius OTA/AO 23-A2,which is usually treated conservatively.Those with open fractures,pathological fracture,severely displaced fracture that needs reduction or multiple injuries were excluded.The participants were divided randomly into 2 groups according to the treatment modalities.Group 1 was treated by plaster of Paris cast(the control group).and Group 2 by modified RJ bandage(the trial group).The difference between the 2 groups was found by the Chi-squared test.The difference was considered statistically significant when the p value was less than 0.05.Results:There were 150 children(aged 2-12 years,any gender)included in the study,75 in each group.The complications occured in 5(3.3%)cases only,pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2.There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment(p=0.649).Children treated by RJ bandages were more comfortable than those treated by the cast(97.3%vs.73.3%,p<0.001)with a statistically significant difference between them.Contrary to that,the families were more satisfied with the cast than RJ bandage(88.0%vs.81.3%),but without a statistically significant difference(p=0.257).Conclusion:RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.

Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal stability.The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.Methods Between March 2008 and June 2011,a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods.Of them,24 patients were treated by perpendicular plating （group Ⅰ） and 21 patients were treated by parallel plating （group Ⅱ）.The surgical time,blood loss,and union time were compared between the two groups.The fiexion-extension arc,the total range of flexion and extension at the end of follow-up were compared between the two groups.The Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up.The mean duration of follow-up was 16 months （range 12-25 months） in group Ⅰ and 15.5 months in group Ⅱ （range 12-25 months）.There were no significant differences in the surgical time,blood loss,and the bone union time between the two groups.In group Ⅰ,the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points.The rate of excellent and good results was 87.5%.In group Ⅱ,the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points.The rate of excellent and good results was 90.5%.There were no significant differences in the MEPS,flexion-extension arc,and the total range of flexion and extension between the two groups.Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation.The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

Distal end radius fractures： evaluation of results of various treatments and assessment of treatment choice

Objective：The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1） closed reduction and Plaster of Paris cast,2） distractor application,or 3） open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods：A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A （extra-articular）,type B （partial articular） and type C （complete articular）.After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results：Anatomical results were evaluated according to the Sarmiento＇s modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion：There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient＇s characteristics,the patient＇s demands and the treating surgeon＇s experience and preference.

Olecranon osteotomy vs.triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture:a systematic review and meta-analysis

Background:The open reduction and internal fixation(ORIF)was a standard treatment approach for fracture at distal humerus intercondylar,whereas the optimal way before ORIF remains inconclusive.We,therefore,performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs.triceps-sparing approach for patients with distal humerus intercondylar fracture.Methods:The electronic searches were systematically performed in PubMed,EmBase,Cochrane library,and Chinese National Knowledge Infrastructure from initial inception till December 2019.The primary endpoint was the incidence of excellent/good elbow function,and the secondary endpoints included Mayo elbow performance score,duration of operation,blood loss,and complications.Results:Nine studies involving a total of 637 patients were selected for meta-analysis.There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function(odds ratio[OR]:1.37;95%confidence interval[CI]:0.69-2.75;P=0.371),Mayo elbow performance score(weight mean difference[WMD]:0.17;95%CI:-2.56 to 2.89;P=0.904),duration of operation(WMD:4.04;95%CI:-28.60 to 36.69;P=0.808),blood loss(WMD:33.61;95%CI:-18.35 to 85.58;P=0.205),and complications(OR:1.93;95%CI:0.49-7.60;P=0.349).Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function,longer duration of operation,greater blood loss,and higher incidence of complications as compared with triceps-sparing approach.Conclusions:This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function,while the duration of operation,blood loss,and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Paratricipital two window approach for complex intraarticular distal humerus fractures: A prospective analysis of 27 patients

Background:To investigate the utility and complications of paratricipital 2 window approach for complex intra articular distal humerus fractures(AO/OTA type C).Methods:Between December 2012 and September 2016,27 patients(male-14,female-13)having mean age of 39 years(range,22-62 years)with closed intra articular fracture(AO/OTA 13 type C)were surgically managed using paratricipital 2 window approach.Fractures were fixed as per AO principles.All patients were followed up for 21 months(range,12-28 months)prospectively.Functional outcome was measured using Mayo Elbow Performance Score(MEPS)and complications were observed.Student ttest,Pearson co-relation coefficient and Kruskal Wallis test used for statistical evaluation.Result:All cases unite by the end of 3 months.Mean flexion achieved was 120°and extension lag was 10°.Mean arc of motion was 111°.Mean pronation and supination was 70°and 77°respectively.MEPS and motion arc were weak negatively co-related with surgical delay and advancement in age.Postoperative transient ulnar nerve palsy and heterotrophic ossification(HO)was noted in 3.7%cases and infection occurred in 7.4%cases.Hardware prominence noted in 11.1%cases.Mean MEPS was 82.MEPS was excellent in 18.5%,good in 62.9%,fair in 11.1%and poor in 7.4%cases.Conclusion:Paratricipital 2 window approach for these fractures had good functional outcome with fewer complications.We advocate paratricipital 2 window approach when dealing with these complex fractures particularly,in type C1 and type C2.

Elbow dislocation and articular fracture of the distal humerus

Objective To describe dislocation of the elbow with articular fracture of the distal humerus,a type of elbow fracture-dislocation about which little has been written.Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified.Three had dislocation and complex intraarticular fracture of the capitellum,trochlea,and lateral epicondyle.Results Two patients(one treated with a second operation to address avascular necrosis of the capitellum)achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing.The fourth patient had a complex open fracture dislocation involving the entire articular surface.An attempt to salvage the articular surface resulted in deep infection.Extensive heterotopic bone led to arthrodesis of the elbow.Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon.Most injuries involve the capitellum,lateral trochlea,and lateral epicondyle.Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.

后外侧入路微型锁定钢板治疗肱骨远端冠状面骨折

2018年6月~2021年9月,山西医科大学第二医院骨科采用后外侧入路微型锁定钢板内固定治疗9例肱骨远端冠状面骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组9例,男3例,女6例,年龄26~61岁。左侧6例,右侧3例。骨折Dubberley分型:ⅠA型1例,ⅡA型3例,ⅡB型3例,ⅢB型2例。合并桡骨头骨折2例,外侧副韧带损伤1例,外上髁撕脱骨折1例。受伤至手术时间5~12 d。

超声引导臂丛神经阻滞麻醉在肱骨远端C型骨折患者的应用效果

目的:探讨超声引导臂丛神经阻滞麻醉在肱骨远端C型骨折患者的应用效果.方法:选取2020年3月-2023年1月我院收治的78例肱骨远端C型骨折患者为研究对象,根据1:1随机掷硬币原则将研究对象分为试验组与传统组,每组39例.传统组采用超声引导锁骨下肌间沟臂丛神经阻滞,试验组采用超声引导喙突旁臂丛神经阻滞.对比2组患者的阻滞效果.结果:试验组不同神经支配区麻醉起效时间均短于传统组,组间差异有统计学意义(P<0.05).试验组麻醉效果优良率高于传统组,差异有统计学意义(P<0.05).试验组并发症发生率低于传统组,差异有统计学意义(P<0.05).术后4、24、48 h,试验组VAS评分均低于传统组,差异有统计学意义(P<0.05).结论:相对于锁骨下肌间沟,超声引导喙突旁臂丛神经阻滞在肱骨远端C型骨折手术上的应用能加快神经支配起效时间,减少并发症的发生,可缓解患者的静息疼痛评分,提高总体麻醉阻滞效果.

Schildhauer入路与鹰嘴截骨入路复位内固定对肱骨远端C型骨折患者关节功能及手术创伤程度的影响

目的探讨Schildhauer入路与鹰嘴截骨入路复位内固定治疗肱骨远端C型骨折患的效果。方法选取2019年1月至2021年1月我院收治的120例肱骨远端C型骨折患者作为研究对象,按术式不同将其分为A组和B组,各60例。A组采用Schildhauer入路复位内固定手术,B组采用鹰嘴截骨入路复位内固定手术。比较两组的治疗效果。结果术后1 d,A组的肾上腺素(E)、皮质醇(Cor)、醛固酮(ALD)水平均低于B组(P<0.05)。A组的手术时间短于B组,术中出血量少于B组(P<0.05)。术后6个月,A组的肘关节外旋、内旋、屈伸活动范围大于B组(P<0.05)。术后6个月,A组的Mayo、Neer评分均高于B组(P<0.05)。两组的术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论Schildhauer入路复位内固定治疗肱骨远端C型骨折患者能减小创伤,改善肘关节活动度,促进肘肩关节功能恢复,值得推广。

Surgical exposures of the distal humeral fractures: An anatomical study of the anterior, posterior, medial and lateral approaches

Purpose:Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.Methods:Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.Results:The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.Conclusion:The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.

改良空心钉复位尺骨鹰嘴截骨结合垂直锁定钢板治疗C型肱骨远端骨折临床效果观察

目的探讨改良空心钉复位尺骨鹰嘴截骨结合垂直锁定钢板治疗C型肱骨远端骨折临床效果。方法回顾选取2016年2月至2021年11月,在北京市垂杨柳医院骨科就诊的C型肱骨远端骨折患者15例,应用尺骨鹰嘴截骨入路治疗,尺骨鹰嘴截骨部复位采用1枚6.5 mm空心钉结合钛缆张力带的复位固定方式,术后支具固定及适当功能练习。结果15例患者均获得随访,切口均一期愈合。术后未出现切口感染、血管神经症状等并发症。肱骨远端骨折均愈合,平均愈合时间12.6周,钢板、螺钉位置良好;尺骨鹰嘴截骨处骨性愈合,未发生移位、骨不连等情况。随着术后愈合时间的增加,术后12个月时,平均肘关节屈曲角度为(119.33±11.63)°。末次随访按照Mayo肘关节功能评分标准,平均85(65~95)分。优7例,良5例,可3例,差0例,优良率80%。结论采用尺骨鹰嘴截骨入路治疗C型肱骨远端骨折效果满意;改良6.5mm空心钉结合钛缆张力带复位尺骨鹰嘴截骨部操作简单,预后良好。

不同入路方式垂直钢板内固定治疗成人肱骨远端C型骨折的临床疗效

目的分析不同入路方式垂直钢板内固定术治疗成人肱骨远端C型骨折的临床疗效。方法选取2015年7月至2019年7月南京医科大学第二附属医院收治的79例成人肱骨远端C型骨折患者,均行外科手术治疗。根据手术中的不同入路方式分为截骨组(38例)和两侧组(41例)。其中,截骨组采用经尺骨鹰嘴截骨入路,两侧组采用经肱三头肌两侧入路。比较两组围手术期指标(手术时间、术中出血量、术后切口引流量、骨愈合时间),血清骨代谢指标[骨钙素、骨碱性磷酸酶(BALP)、总Ⅰ型前胶原氨基端延长肽(T-P1NP)]、关节活动度(ROM)、肘关节功能变化及并发症发生率。结果两侧组患者的手术时间短于截骨组[(84±64)min比(115±12)min](P<0.01),术中出血量、术后切口引流量少于截骨组[(153±21)ml比(190±32)ml、(78±20)ml比(111±22)ml](P<0.01)。骨钙素、BALP、T-P1NP水平时点间与组间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。出院时,两组患者的骨钙素水平均较术后1 d升高,且两侧组高于截骨组(P<0.05);BALP、T-P1NP水平较术后1 d降低,且两侧组低于截骨组(P<0.05)。随访3个月时,两侧组患者的屈曲度、旋前度、旋后度均大于截骨组[(144.78±9.17)°比(130.90±9.98)°、(86.91±0.91)°比(77.91±1.12)°、(83.02±1.29)°比(75.28±1.07)°](均P<0.01)。两组患者的总优良率、总并发症发生率比较差异均无统计学意义(P>0.05)。结论经肱三头肌两侧入路暴露骨折端及关节面的效果略差于经尺骨鹰嘴截骨入路,适用于C1型、C2型骨折;经尺骨鹰嘴截骨入路可更加充分暴露骨折端及关节面,适用于C3型骨折,临床可根据患者实际情况灵活应用入路方式。