Nalbantoğlu Ufuk, Gereli Arel, Kocaoğlu Bariş, Haklar Uğur, Türkmen Metin
Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery (Ortopedi ve Travmatoloji Bölümü, El ve Ust Ekstremite Cerrahisi Servisi), Acibadem Kadiköy Hospital, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2008 Mar-Apr;42(2):112-8.
This study was designed to assess the results of surgical treatment for type 2-3 coronoid process fractures and to identify factors that might influence the outcome.
Thirteen male patients (mean age 35 years; range 17 to 53 years) were treated with open reduction and internal fixation for displaced coronoid fractures. According to the Regan-Morrey classification, the fractures were type 2 in nine patients (69.2%), and type 3 in four patients (30.8%). Nine patients had associated injuries (elbow dislocation, radial head or olecranon fractures, and/or ligamentous injuries). The mean duration to treatment was 2.3 days (range 1 to 7 days). Functional results were assessed according to the Mayo elbow performance score (MEPS), and signs of arthritis were assessed according to the Broberg-Morrey criteria. The mean follow-up was 41.1 months (range 12 to 96 months).
A functional range of motion of the elbow joint was achieved in 10 patients (76.9%). The mean elbow range of motion was 110.7 degrees (range 85 degrees to 130 degrees ) and the mean forearm rotation was 134.2 degrees (range 120 degrees to 155 degrees ). Three patients who had comminuted fractures and associated elbow injuries had decreased range of motion. None of the patients exhibited signs of instability. The mean MEPS was 86.5 (range 75 to 100). The results were excellent in four patients (30.8%; the mean MEPS 98.8) having isolated or noncomminuted coronoid fractures, and good in nine patients (69.2%) with comminuted fractures and/or associated bone or ligament injuries. Post-traumatic arthritis was detected in seven patients (53.9%) whose mean MEPS was 81.4. Patients with an excellent functional result did not develop arthritis. All the patients returned to preinjury activity levels.
Coronoid fractures are the most important component of complex elbow injuries. The presence of comminuted fractures, associated bone and ligament injuries, and post-traumatic arthritis affect the outcome adversely.
本研究旨在评估2 - 3型冠突骨折的手术治疗结果，并确定可能影响预后的因素。
13例男性患者（平均年龄35岁；年龄范围17至53岁）因移位性冠突骨折接受切开复位内固定治疗。根据Regan - Morrey分类，9例患者（69.2%）为2型骨折，4例患者（30.8%）为3型骨折。9例患者伴有其他损伤（肘关节脱位、桡骨头或尺骨鹰嘴骨折和/或韧带损伤）。平均治疗时间为2.3天（范围1至7天）。根据Mayo肘关节功能评分（MEPS）评估功能结果，根据Broberg - Morrey标准评估关节炎体征。平均随访时间为41.1个月（范围12至96个月）。
10例患者（76.9%）实现了肘关节的功能活动范围。肘关节平均活动范围为110.7度（范围85度至130度），前臂平均旋转度为134.2度（范围120度至155度）。3例粉碎性骨折并伴有肘关节损伤的患者活动范围减小。所有患者均未表现出不稳定体征。平均MEPS为86.5（范围75至100）。4例（30.8%；平均MEPS 98.8）孤立性或非粉碎性冠突骨折患者结果为优，9例粉碎性骨折和/或伴有骨或韧带损伤患者结果为良。7例患者（53.9%）检测到创伤后关节炎，其平均MEPS为81.4。功能结果为优的患者未发生关节炎。所有患者均恢复到伤前活动水平。
冠突骨折是复杂肘关节损伤的最重要组成部分。粉碎性骨折、伴有骨和韧带损伤以及创伤后关节炎对预后有不利影响。
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