Doornberg Job N, Ring David C
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2006 Oct;88(10):2216-24. doi: 10.2106/JBJS.E.01127.
Fracture of the anteromedial facet of the coronoid was recently recognized as a distinct type of coronoid fracture resulting from a varus posteromedial rotational injury force. Very few reports are available to help guide the management of these injuries.
Eighteen patients with a fracture of the anteromedial facet of the coronoid process were treated over a six-year period. Twelve patients were treated for the acute fracture, and six were managed after initial treatment elsewhere. All but three patients (two with concomitant fracture of the olecranon and one with a second fracture at the base of the coronoid) had avulsion of the origin of the lateral collateral ligament complex from the lateral epicondyle. The initial treatment was operative in fifteen patients and nonoperative in three. The coronoid fracture was secured with a plate applied to the medial surface of the coronoid in nine patients, a screw in one patient, and sutures in one patient. It was not repaired in the remaining seven patients.
At the final evaluation, an average of twenty-six months after the injury, six patients had malalignment of the anteromedial facet of the coronoid with varus subluxation of the elbow, which was due to the fact that the fracture had not been specifically treated in four patients and to loss of fracture fixation in two patients. All six had development of arthrosis and a fair or poor result according to the system of Broberg and Morrey. The remaining twelve patients had good or excellent elbow function.
Anteromedial fractures of the coronoid are associated with either subluxation or complete dislocation of the elbow in most patients. Secure fixation of the coronoid fracture usually restores good elbow function.
冠突前内侧小关节骨折最近被认为是一种由内翻后内侧旋转暴力导致的独特类型的冠突骨折。目前关于指导此类损伤治疗的报道非常少。
在六年时间里，我们共治疗了18例冠突前内侧小关节骨折患者。其中12例为急性骨折患者，6例是在其他地方接受初始治疗后转来的。除3例患者（2例合并鹰嘴骨折，1例冠突基部有二次骨折）外，所有患者均有外侧副韧带复合体起点从外侧髁撕脱。15例患者接受了手术治疗，3例接受非手术治疗。9例患者采用钢板固定于冠突内侧面治疗冠突骨折，1例使用螺钉，1例使用缝线。其余7例患者未进行修复。
在最终评估时，平均受伤后26个月，6例患者出现冠突前内侧小关节对线不良伴肘关节内翻半脱位，其中4例是因为骨折未得到特殊治疗，2例是因为骨折固定失败。根据Broberg和Morrey评分系统，这6例患者均出现了关节病，结果为一般或较差。其余12例患者肘关节功能良好或优秀。
大多数冠突前内侧骨折患者会出现肘关节半脱位或完全脱位。牢固固定冠突骨折通常可恢复良好的肘关节功能。
