Department of Orthopaedic Surgery, University Sapienza of Rome, Rome, Italy.
Acta Orthop. 2010 Apr;81(2):228-33. doi: 10.3109/17453671003685475.
The current surgical treatment for displaced fracture of the capitellum and trochlea is open reduction and internal fixation (ORIF), but the results are often unsatisfactory, particularly with complex fractures. Furthermore, the surgical approach, the kind of osteosynthesis, and postoperative management are controversial. We evaluated the results of internal fixation combined with hinged external fixation.
We analyzed 15 patients with a mean age of 47 (18-65) years. Based on the Bryan-Morrey-McKee classification, the fractures were identified as type I in 6 cases and type IV in 9. Active and passive motion was started and activities of daily living were permitted on the second postoperative day. The mean follow-up time was 29 (12-49) months.
In 13 cases, functional range of motion was obtained within 6 weeks of surgery. At final follow-up, 14 patients had a stable, pain-free elbow with a mean active range of motion of 13 degrees to 140 degrees . The average score on the Mayo elbow performance score was 98.
The use of the hinged fixator allows early motion of the elbow while preserving joint stability. It may have additional value in complex articular fractures when stable internal fixation cannot be obtained with ORIF, and in the presence of severe ligamentous injuries.
目前，治疗肱骨小头和滑车移位骨折的方法是切开复位内固定（ORIF），但效果往往不尽如人意，尤其是对于复杂骨折。此外，手术入路、内固定类型和术后管理存在争议。我们评估了铰链外固定联合内固定的治疗效果。
我们分析了 15 例平均年龄为 47 岁（18-65 岁）的患者。根据 Bryan-Morrey-McKee 分类，6 例为Ⅰ型骨折，9 例为Ⅳ型骨折。术后第 2 天开始主动和被动活动，允许日常生活活动。平均随访时间为 29 个月（12-49 个月）。
13 例患者在术后 6 周内获得了功能范围的运动。最终随访时，14 例患者肘部稳定无痛，平均主动活动范围为 13°至 140°。Mayo 肘部功能评分平均为 98 分。
铰链固定器的使用允许早期活动肘部，同时保持关节稳定性。当 ORIF 无法获得稳定的内固定时，对于复杂的关节骨折，以及存在严重韧带损伤时，它可能具有额外的价值。
