O'Driscoll Shawn W, Jupiter Jesse B, Cohen Mark S, Ring David, McKee Michael D
Department of Orthopedic Surgery, Mayo Foundation, Rochester, Minnesota, USA.
Instr Course Lect. 2003;52:113-34.
Complex elbow fractures are exceedingly challenging to treat. Treatment of severe distal humeral fractures fails because of either displacement or nonunion at the supracondylar level or stiffness resulting from prolonged immobilization. Coronal shear fractures of the capitellum and trochlea are difficult to repair and may require extensile exposure. Olecranon fracture-dislocations are complex fractures of the olecranon associated with subluxation or dislocation of the radial head and/or the coronoid process. The radioulnar relationship usually is preserved in anterior but disrupted in posterior fracture-dislocations. A skeletal distractor can be useful in facilitating reduction. Coronoid fractures can be classified according to whether the fracture involves the tip, the anteromedial facet, or the base (body) of the coronoid. Anteromedial coronoid fractures are actually varus posteromedial rotatory fracture subluxations and are often serious injuries. These patterns of injury predict associated injuries and instability as well as surgical approach and treatment. The radial head is the bone most commonly fractured in the adult elbow. If the coronoid is fractured, the radial head becomes a critical factor in elbow stability. Its role becomes increasingly important as other soft-tissue and bony constraints are compromised. Articular injury to the radial head is commonly more severe than noted on plain radiographs. Fracture fragments are often anterior. Implants applied to the surface of the radial head must be placed in a safe zone.
复杂的肘部骨折治疗极具挑战性。严重的肱骨远端骨折治疗失败的原因，要么是髁上水平的移位或骨不连，要么是长期固定导致的僵硬。肱骨小头和滑车的冠状面剪切骨折难以修复，可能需要广泛显露。鹰嘴骨折脱位是与桡骨头和/或冠突半脱位或脱位相关的复杂鹰嘴骨折。在前侧骨折脱位中，桡尺关系通常得以保留，但在后侧骨折脱位中则会遭到破坏。骨骼撑开器有助于复位。冠突骨折可根据骨折是否累及冠突尖、前内侧小关节面或冠突基底（体部）进行分类。前内侧冠突骨折实际上是内翻后内侧旋转骨折半脱位，通常是严重损伤。这些损伤模式可预测相关损伤和不稳定情况，以及手术入路和治疗方法。桡骨头是成人肘部最常发生骨折的部位。如果冠突骨折，桡骨头就成为肘部稳定性的关键因素。随着其他软组织和骨结构的受损，其作用变得愈发重要。桡骨头的关节损伤通常比X线平片显示的更为严重。骨折碎片往往位于前方。应用于桡骨头表面的植入物必须放置在安全区域。
