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The Diagnosis and Treatment of Criss-Cross Injury of The Forearm: A Retrospective Analysis 前臂十字交叉伤的诊断与治疗:回顾性分析
Pub Date : 2023-12-01 DOI: 10.1016/j.injury.2023.111295
Tan Jie, Xiong Jie, Xigong Zhang, Minghui Yang, Li Ting, Gong Maoqi
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引用次数: 0
AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment? 75 岁及以上患者的 AO/OTA C3 型肱骨远端骨折:使用双预成形解剖锁定钢板的ORIF是一种可靠的治疗方法吗?
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.111043
Héctor J Aguado, Juan Mingo-Robinet, Virginia García-Virto, Iñigo SanJose-Pardo, Sergio Pais, Begoña A Álvarez-Ramos, Clarisa Simón-Pérez, David C Noriega

Introduction: The incidence of osteoporotic distal humeral fractures (DHF) is on the rise. Their operative management is demanding. Fixation with non-locking reconstruction plates was associate with a high number of complications. Elbow arthroplasty (total or hemi) has been proposed as an alternative treatment, in spite of lifetime activity restrictions, and risk of complications, unknown implant survival and problematic revision surgery. Precontoured anatomical locking plates have increased the strength of the fixation in complex fractures.

Hypothesis: double plating ORIF with precontoured anatomical locking plates is a safe and reliable treatment option for the management of AO/OTA type C3 DHF in patients aged 75 and older.

Patients and methods: A retrospective case series study of patients aged 75 years old and older with an AO/OTA type C3 DHF treated with ORIF with double precontoured anatomical locking plates between 2007 and 2021. Pathologic fractures were excluded. Patients' demographic, surgical, clinical, and radiological data were reviewed.

Results: A total of 27 women and 3 men, mean age of 80.1 years (range 75-93 years), were included. Mean Charlson index was 5 (range 3-8). Out of 30 patients, 19 had already died. Mean survival time after the surgical treatment was 72.3 months. Mean Mayo elbow performance score was 88.9 (range 60-100); 23 patients scored excellent or good. All fractures healed with no cases of delay union or non-union, hardware failure or loss of reduction. No patient needed a revision surgery to arthroplasty. The total number of complications was 12 (40%), mainly ulnar neuropathy (5) and cerclage removal (4).

Conclusion: ORIF with double pre-contoured locking plates may be a safe and reliable treatment for type C3 DHF in patients aged 75 years and older, with a good functional outcome. Complications are expected but not related to loss of reduction, fixation failure or revision to elbow arthroplasty.

简介骨质疏松性肱骨远端骨折(DHF)的发病率呈上升趋势。其手术治疗要求很高。使用非锁定重建钢板进行固定的并发症较多。尽管终生活动受限、并发症风险高、植入物存活率未知以及翻修手术问题重重,但肘关节成形术(全肘或半肘)仍被建议作为一种替代治疗方法。假设:在治疗 75 岁及以上患者的 AO/OTA C3 型 DHF 时,使用预弯解剖锁定钢板的双钢板 ORIF 是一种安全可靠的治疗方案:一项回顾性病例系列研究,研究对象为2007年至2021年期间使用双预收缩解剖锁定钢板进行ORIF治疗的75岁及以上AO/OTA C3型DHF患者。病理骨折除外。回顾了患者的人口统计学、手术、临床和放射学数据:共纳入 27 名女性和 3 名男性,平均年龄为 80.1 岁(75-93 岁不等)。平均查尔森指数为 5(范围为 3-8)。30 名患者中有 19 人已经死亡。手术治疗后的平均存活时间为 72.3 个月。梅奥肘关节功能评分的平均值为 88.9(范围为 60-100);23 名患者的评分为优或良。所有骨折均愈合,无延迟愈合或不愈合、硬件故障或复位损失。没有患者需要进行关节置换翻修手术。并发症总数为12例(40%),主要是尺神经病变(5例)和钢圈拆除(4例):结论:对于75岁及以上的C3型DHF患者来说,使用双预轮廓锁定钢板进行ORIF可能是一种安全可靠的治疗方法,并能获得良好的功能效果。并发症是可以预料的,但与缩径损失、固定失败或肘关节置换术翻修无关。
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引用次数: 0
Functional survival of cementless trapeziometacarpal total joint arthroplasty after upper extremity trauma. 上肢创伤后无骨水泥肩胛骨全关节成形术的功能存活率。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.111156
C Simón-Pérez, S Chavez Valladares, J I Rodríguez-Mateos, M Plata Garcia, V Garcia Virto, H J Aguado, M A Martín-Ferrero

Introduction: Our purpose with this publication is to document the survival of uncemented and unconstrained total trapeziometacarpal arthroplasty after energy trauma to the upper extremity.

Material and methods: From 1999 to the present, ten patients carrying total TMC arthroplasty suffered major traumatic injuries on the hand. Eight patients had fractures of the distal radius, one patient had scapho-lunate dissociation and one patient had a dorsal pullout of the triquetrum. A clinical and radiological examination of the patients after the trauma was carried out and compared with the pre-traumatic prosthesis status.

Results: Three patients required surgical intervention for the associated traumatic injury. The postraumatic clinical and functional follow-up of the patients was good, and no differences were documented with respect to mobility, strength and pain at the level of the thumb with respect to the prior to the trauma. No signs of loosening, instability or alteration in the alignment of the components of the protheses were observed in the radiological examinations following the trauma.

Conclusions: There is a high survival rate of uncemented total trapeziometacarpal arthroplasty in the long term, even in the face of energy trauma. It is then a safe implant. Despite of being non-constrained, a good alignment of the prosthetic components is the key to avoid dislocation of the prosthesis.

导言:我们发表这篇文章的目的是记录上肢能量创伤后非粘结和非受限全梯形掌关节成形术的存活情况:从 1999 年至今,10 名接受全掌桡骨和掌骨关节置换术的患者手部遭受了重大创伤。八名患者为桡骨远端骨折,一名患者为肩胛-月骨分离,一名患者为三棱肌背侧牵拉。对患者进行了创伤后的临床和放射学检查,并与创伤前的假体状态进行了比较:结果:三名患者因相关创伤需要手术治疗。患者创伤后的临床和功能随访情况良好,拇指水平的活动度、力量和疼痛与创伤前没有差异。在创伤后的放射学检查中,没有发现假体松动、不稳定或对位改变的迹象:结论:即使是在能量创伤的情况下,非骨水泥全掌骨关节置换术的长期存活率也很高。因此,这是一种安全的植入物。尽管不受约束,但假体部件的良好对位是避免假体脱位的关键。
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引用次数: 0
Injuries around the upper limb. Latest Spanish experience. 上肢周围受伤。西班牙最新经验。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.05.040
Carlos Olaya-González
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引用次数: 0
Reverse total shoulder arthroplasty for proximal humerus fractures: Primary or delayed after failed treatment? 肱骨近端骨折的反向全肩关节置换术:初治还是治疗失败后延迟?
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.111040
D González-Quevedo, N Fernández-Arroyabe, D J Moriel-Garceso, F J Martínez-Malo, F Martín-García, J Arenas-Ros, S Zambrana-Vico, L Puerta-Migueles, M Sáez-Casado, A Sánchez-García, I Tamimi

Background: Reverse total shoulder arthroplasty (RTSA) has recently become an option for the treatment of proximal humerus fractures (PHFs) or as a salvage procedure after failure of another treatment. The purpose of this study was to compare primary RTSA with delayed RTSA in the treatment of displaced PHFs.

Study design & methods: A retrospective cohort study was conducted on patients with PHFs who were treated between May 2013 and December 2021 with primary or delayed RTSA after failure of conservative treatment or osteosynthesis. Clinical data were withdrawn from our local computerized database. Complications, active range of motion, as well as the functional outcome were recorded at the end of the follow-up period. Differences between clinical outcomes were analyzed using a logistic regression analysis.

Results: A total of 70 individuals were included in this study (41 primary RTSA and 29 delayed RTSA). The mean of follow-up time was of 112 and 60 months, respectively. There were no differences between groups regarding fracture type according Neer Classification, ASA score or the presence of complications. Q-DASH and Oxford Shoulder scores were significantly better when patients underwent a primary RTSA (49.8 vs 31.4, p = 0.006 and 37.2 vs 27.5, p = 0.004 respectively). In addition, primary RTSA achieved more degrees of flexion and abduction than delayed RTSA (96.8 vs 72.9, p < 0.001 and 94.1 vs 69.3, p < 0.001 respectively).

Conclusion: Primary RTSA for PHFs achieved better functional outcomes and a wider range of motion when compared with delayed RTSA. However, primary and delayed RTSA have similar complication and reintervention rates.

Level of clinical evidence: 3.

背景:反向全肩关节置换术(RTSA)近来已成为治疗肱骨近端骨折(PHF)或其他治疗失败后的一种挽救手术。本研究的目的是比较初次RTSA与延迟RTSA在治疗移位肱骨近端骨折中的效果:本研究对2013年5月至2021年12月期间,在保守治疗或骨合成术失败后接受初次或延迟RTSA治疗的PHFs患者进行了回顾性队列研究。临床数据来自本地计算机数据库。随访结束时记录了并发症、活动范围以及功能结果。临床结果之间的差异采用逻辑回归分析法进行分析:本研究共纳入了 70 名患者(41 名原发性 RTSA 患者和 29 名延迟性 RTSA 患者)。平均随访时间分别为 112 个月和 60 个月。根据Neer分类法、ASA评分或并发症的出现情况,两组患者的骨折类型无差异。接受初级 RTSA 的患者 Q-DASH 和牛津肩关节评分明显更高(分别为 49.8 分 vs 31.4 分,p = 0.006 和 37.2 分 vs 27.5 分,p = 0.004)。此外,初级 RTSA 比延迟 RTSA 获得了更多的屈曲度和外展度(96.8 对 72.9,P=0.004):与延迟 RTSA 相比,初级 RTSA 治疗 PHF 的功能效果更好,活动范围更广。然而,初级和延迟RTSA的并发症和再干预率相似:3.
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引用次数: 0
Anatomic pattern of perforator arteries from proper digital arteries in human triphalangeal digits. 人类三指指骨适当数字动脉穿孔动脉的解剖模式。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.111062
Fernando Navío-Fernández, Fernando Corella, Montserrat Ocampos, Esther Pastor-Fernández, Teresa Vázquez

Introduction: The localization of the perforator artery for the performance of digital artery perforator (DAP) flaps poses a challenge. This study aims to describe the anatomical pattern of the perforator arteries originating from the proper digital artery in fresh cadaveric triphalangeal digits and to use this pattern as a point of reference for performing these flaps.

Material and method: We performed a descriptive anatomical study on 28 fresh cadaveric hands (14 male, 14 female; 10 right hands, 18 left hands) after injecting the arterial system with latex. Digital photographs were taken of each specimen after dissection and the number of perforator arteries in each finger (second to fifth), phalanx (proximal, middle and distal) and finger side (radial or ulnar) were obtained by analysis in Adobe Photoshop CS6.

Results: We obtained statistically significant results when comparing the means of the number of perforator arteries between fingers, phalanx, finger side, gender and laterality. When analyzing the number of perforator arteries in each phalanx third in each finger, we found that more than 75% of specimens had at least one perforator artery in the two distal thirds of the proximal phalanx and the three-thirds of the middle phalanx and more than 50% had at least one in the proximal third of the distal phalanx.

Conclusions: We present a homogeneous perforator artery anatomic pattern, by finger, phalanx, finger side, gender and laterality, consisting of a high density of perforator arteries in the distal proximal phalanx region, throughout the middle phalanx and in the proximal distal phalanx region, which would be the areas of greatest certainty to help predict the favorable evolution of a digital artery perforator flap in the fingers.

介绍:在进行数字动脉穿孔器(DAP)皮瓣手术时,穿孔动脉的定位是一项挑战。本研究旨在描述新鲜尸体三指指腹中源自适当数字动脉的穿孔动脉的解剖模式,并将该模式作为实施这些皮瓣的参考点:用乳胶注射动脉系统后,我们对 28 只新鲜尸体手(14 男,14 女;10 右手,18 左手)进行了描述性解剖研究。每个标本在解剖后都拍摄了数码照片,并通过 Adobe Photoshop CS6 进行分析,获得了每个手指(第二至第五指)、指骨(近端、中间和远端)和指侧(桡侧或尺侧)的穿孔动脉数量:比较不同手指、指骨、指侧、性别和侧位之间穿孔动脉数量的平均值,结果具有统计学意义。在分析每个手指每个指骨三分之一处的穿孔动脉数量时,我们发现超过 75% 的标本在近节指骨的远端三分之二处和中节指骨的三分之二处至少有一条穿孔动脉,超过 50% 的标本在远节指骨的近端三分之一处至少有一条穿孔动脉:根据手指、指骨、指侧、性别和侧位的不同,我们发现了一种同质的穿孔动脉解剖模式,即在近节指骨远端区域、整个中节指骨和远节指骨近端区域存在高密度的穿孔动脉。
{"title":"Anatomic pattern of perforator arteries from proper digital arteries in human triphalangeal digits.","authors":"Fernando Navío-Fernández, Fernando Corella, Montserrat Ocampos, Esther Pastor-Fernández, Teresa Vázquez","doi":"10.1016/j.injury.2023.111062","DOIUrl":"10.1016/j.injury.2023.111062","url":null,"abstract":"<p><strong>Introduction: </strong>The localization of the perforator artery for the performance of digital artery perforator (DAP) flaps poses a challenge. This study aims to describe the anatomical pattern of the perforator arteries originating from the proper digital artery in fresh cadaveric triphalangeal digits and to use this pattern as a point of reference for performing these flaps.</p><p><strong>Material and method: </strong>We performed a descriptive anatomical study on 28 fresh cadaveric hands (14 male, 14 female; 10 right hands, 18 left hands) after injecting the arterial system with latex. Digital photographs were taken of each specimen after dissection and the number of perforator arteries in each finger (second to fifth), phalanx (proximal, middle and distal) and finger side (radial or ulnar) were obtained by analysis in Adobe Photoshop CS6.</p><p><strong>Results: </strong>We obtained statistically significant results when comparing the means of the number of perforator arteries between fingers, phalanx, finger side, gender and laterality. When analyzing the number of perforator arteries in each phalanx third in each finger, we found that more than 75% of specimens had at least one perforator artery in the two distal thirds of the proximal phalanx and the three-thirds of the middle phalanx and more than 50% had at least one in the proximal third of the distal phalanx.</p><p><strong>Conclusions: </strong>We present a homogeneous perforator artery anatomic pattern, by finger, phalanx, finger side, gender and laterality, consisting of a high density of perforator arteries in the distal proximal phalanx region, throughout the middle phalanx and in the proximal distal phalanx region, which would be the areas of greatest certainty to help predict the favorable evolution of a digital artery perforator flap in the fingers.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Locking plate versus retrograde intramedullary headless compression screw for unstable extra-articular metacarpal base fractures of the thumb. 锁定钢板与逆行无头髓内加压螺钉治疗不稳定的拇指关节外掌基底骨折。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.110891
Sergi Barrera-Ochoa, Maximiliano Ibañez, Soldado Francisco, Rita Sapage, Sergi Alabau-Rodríguez, Xavier Mir-Bullo

The purpose was to compare clinical and radiological outcomes between two fixation techniques used to treat extra-articular fractures involving the base of the thumb metacarpal: retrograde intramedullary cannulated headless screw (RICHS) and locking plate (LP). Fifty-one patients who underwent RICHS (n = 22) or LP fixation (n = 29) from January 2010 through 2020 were included in this retrospective case-control study with mean follow-up 39 months. No inter-group differences were observed comparing mean time to radiological union, grip strength, range of motion, pain severity or QuickDASH scores. Mean surgery time was shorter with RICHS (18.9 min) than with LP fixation (44.4 min). Mean time to return to work or routine activities was less in RICHS than LP (22 vs. 32 days), as was the percentage of patients requiring hardware removal (0% vs. 44.8%). We conclude that RICHS fixation requires less operating time and yields faster post-operative return to full function and fewer secondary procedures.

目的是比较两种用于治疗涉及拇指掌骨基底部的关节外骨折的固定技术:逆行髓内无头螺钉(RICHS)和锁定钢板(LP)的临床和放射学结果。这项回顾性病例对照研究纳入了从 2010 年 1 月到 2020 年接受 RICHS(22 例)或 LP 固定(29 例)的 51 例患者,平均随访时间为 39 个月。比较平均放射学结合时间、握力、活动范围、疼痛严重程度或 QuickDASH 评分,未观察到组间差异。RICHS的平均手术时间(18.9分钟)短于LP固定术(44.4分钟)。与 LP 相比,RICHS 恢复工作或日常活动的平均时间更短(22 天 vs. 32 天),需要移除硬件的患者比例也更低(0% vs. 44.8%)。我们的结论是,RICHS固定所需的手术时间更短,术后恢复功能更快,二次手术更少。
{"title":"Locking plate versus retrograde intramedullary headless compression screw for unstable extra-articular metacarpal base fractures of the thumb.","authors":"Sergi Barrera-Ochoa, Maximiliano Ibañez, Soldado Francisco, Rita Sapage, Sergi Alabau-Rodríguez, Xavier Mir-Bullo","doi":"10.1016/j.injury.2023.110891","DOIUrl":"10.1016/j.injury.2023.110891","url":null,"abstract":"<p><p>The purpose was to compare clinical and radiological outcomes between two fixation techniques used to treat extra-articular fractures involving the base of the thumb metacarpal: retrograde intramedullary cannulated headless screw (RICHS) and locking plate (LP). Fifty-one patients who underwent RICHS (n = 22) or LP fixation (n = 29) from January 2010 through 2020 were included in this retrospective case-control study with mean follow-up 39 months. No inter-group differences were observed comparing mean time to radiological union, grip strength, range of motion, pain severity or QuickDASH scores. Mean surgery time was shorter with RICHS (18.9 min) than with LP fixation (44.4 min). Mean time to return to work or routine activities was less in RICHS than LP (22 vs. 32 days), as was the percentage of patients requiring hardware removal (0% vs. 44.8%). We conclude that RICHS fixation requires less operating time and yields faster post-operative return to full function and fewer secondary procedures.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Blood transfusion and surgical treatment increase mortality in patient with proximal humeral fractures. 输血和手术治疗会增加肱骨近端骨折患者的死亡率。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.111091
Ana Belén Fernández-Cortiñas, Teresa Seoane-Pillado, Fernando Marco Martínez

Introduction: Proximal humeral fractures (PHFs) often occur in elderly patients with osteoporosis and associated comorbidities. These patients constitute a special risk group. This study aimed to identify associations between comorbidities, treatment type, and mortality risk.

Patients and methods: We conducted a retrospective chart review of a cohort of 350 patients with a diagnosis of PHF and a mean follow-up of 4.5 years. We analysed the 19 prefracture comorbidities included in the Charlson Comorbidity Index (CCI), haemoglobin (Hb) levels, blood transfusion needs, and treatment administered (surgery versus conservative). The nonparametric Kaplan-Meier method and Cox proportional hazards model were used to estimate the mortality risk.

Results: Over a 4.5-year average follow-up of 350 patients, primarily elderly females, with proximal humerus fractures, several factors were associated with increased mortality. The Charlson Comorbidity Index (CCI) was a significant predictor, with patients having a CCI > 5 facing higher mortality risks, especially if they underwent surgery. Additionally, osteosynthesis was linked to a lower mortality rate compared to arthroplasty. Age, dementia, medical complications, and postfracture Hb level also influenced mortality rates. CONCLUSIóN: These findings emphasize the importance of considering comorbidities, specifically the Charlson Comorbidity Index (CCI), in determining patient outcomes, especially amongst elderly patients with proximal humerus fractures. Factors like age, dementia, and postfracture Hb level also play a crucial role in influencing mortality rates.

Trial registration: The study received written approval from the regional Ethics Committee for Clinical Research (code 2016/125).

简介:肱骨近端骨折(PHF)经常发生在患有骨质疏松症和相关合并症的老年患者身上。这些患者构成了一个特殊的风险群体。本研究旨在确定合并症、治疗类型和死亡风险之间的关联:我们对 350 名确诊为 PHF 的患者进行了回顾性病历审查,平均随访时间为 4.5 年。我们分析了查尔森合并症指数(CCI)中包含的 19 种骨折前合并症、血红蛋白(Hb)水平、输血需求和治疗方法(手术与保守)。采用非参数 Kaplan-Meier 法和 Cox 比例危险模型估算死亡风险:在对 350 名肱骨近端骨折患者(主要是老年女性)进行的平均为期 4.5 年的随访中,有几个因素与死亡率的增加有关。夏尔森综合症指数(CCI)是一个重要的预测因素,CCI>5的患者面临更高的死亡风险,尤其是接受手术的患者。此外,与关节置换术相比,骨合成术的死亡率较低。年龄、痴呆症、内科并发症和骨折后血红蛋白水平也会影响死亡率。结论:这些研究结果强调了考虑合并症,特别是夏尔森合并症指数(CCI)对确定患者预后的重要性,尤其是肱骨近端骨折的老年患者。年龄、痴呆症和骨折后血红蛋白水平等因素也是影响死亡率的关键因素:该研究获得了地区临床研究伦理委员会的书面批准(代码 2016/125)。
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引用次数: 0
Influence of Coronoid fixation on the functional outcome and rate of complications in surgically treated acute complex elbow instability. 冠状面固定对手术治疗急性复杂性肘关节不稳的功能结果和并发症发生率的影响。
Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI: 10.1016/j.injury.2023.110892
Samuel A Antuña, Riccardo Raganato, Lucia Ros Dopico, Raúl Barco

Introduction: Fractures of the coronoid commonly present in elbow fracture-dislocations. Despite the evidence that the coronoid plays an important role in elbow stability, there is still controversy on which fractures should be surgically fixed. The aim of this study is to compare the clinical outcomes and rate of complications of patients with elbow fracture-dislocations in which the coronoid was fixed or left untreated.

Materials and methods: Thirty-nine patients with an elbow fracture-dislocation involving a coronoid fracture were prospectively followed for an average of 90 months (range 24-190). According to Morrey´s classification there were 22 type II and 8 type III. Nine patients had an anteromedial fracture of the coronoid. In 24 patients the coronoid was repaired (suture fixation in 9, screws fixation in 10 and plate fixation in 5) and in 15 patients the coronoid was not fixed. In 18 patients the radial head was replaced and in 8 patients it was fixed. All patients underwent repair of the lateral ligament complex. Clinical evaluation was performed with the MEPS. Radiographically, the rate of coronoid nonunion was specifically analyzed. Postoperative neurological complications were recorded.

Results: At the most recent follow up, the average arc of flexion-extension was 120° (range 70°-140°) with a mean MEPS of 90 (range 25-100). No statistically significant differences were found in the MEPS and flexion-extension arc between the patients in whom synthesis was performed (117° ROM, and 89 MEPS) and those in whom it was not (122° ROM, 94 MEPS) (p = 0.42; p = 0.34). Coronoid fracture healing could be assessed in 36 patients: in 19 patients the coronoid was radiographically healed, and in 17 a nonunion was present, with no difference in the final clinical outcome between both groups. Nine patients, 6 of whom had undergone coronoid fixation, had a neurological complication related to the ulnar nerve.

Conclusions: Coronoid fractures affecting around 50% of its height can be treated without internal fixation as long as the rest of the osteo-ligamentous structures are adequately repaired. Osteosynthesis of the coronoid through a medial approach may carry a non-negligible risk of associated neurological injury.

导言:冠状突骨折常见于肘部骨折脱位。尽管有证据表明冠状突在肘关节稳定性方面发挥着重要作用,但对于哪些骨折应进行手术固定仍存在争议。本研究的目的是比较肘部骨折脱位患者在冠状突固定和不固定两种情况下的临床疗效和并发症发生率:对39名肘关节骨折脱位伴冠状突骨折的患者进行了平均90个月(24-190个月)的前瞻性随访。根据莫雷分类法,其中22例为II型,8例为III型。9名患者的冠状突前内侧骨折。24例患者的冠状突得到了修复(9例缝合固定,10例螺钉固定,5例钢板固定),15例患者的冠状突未得到固定。18名患者更换了桡骨头,8名患者固定了桡骨头。所有患者都进行了外侧韧带复合体修复。临床评估通过 MEPS 进行。在X光片上,对冠状骨不连的发生率进行了具体分析。记录了术后神经系统并发症:在最近的随访中,患者的平均屈伸弧度为 120°(范围为 70°-140°),平均 MEPS 为 90(范围为 25-100)。在MEPS和屈伸弧度方面,进行过综合治疗的患者(117° ROM和89 MEPS)与未进行综合治疗的患者(122° ROM和94 MEPS)之间没有发现明显的统计学差异(P = 0.42;P = 0.34)。有36名患者的冠状面骨折愈合情况可以进行评估:19名患者的冠状面骨折在影像学上已经愈合,17名患者的冠状面骨折出现了不愈合,两组患者的最终临床结果没有差异。9名患者(其中6人接受了冠状突固定术)出现了与尺神经有关的神经并发症:结论:只要骨韧带结构的其他部分得到充分修复,影响约50%高度的冠状面骨折无需内固定即可治疗。通过内侧入路对冠状面进行骨合成可能会带来不可忽视的相关神经损伤风险。
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引用次数: 0
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Injury
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