Orthopaedics, Traumatology, plastic and reconstructive surgery and Hand salvage Department, EA 4268 Innovation, Imaging, Engineering and Healthcare policy Division, IFR 133 Inserm, Innovation and Surgical Technique sub-unit, Jean Minjoz Teaching hospital Center, Franche Comté University, Besançon, France.
Orthop Traumatol Surg Res. 2010 Nov;96(7):734-40. doi: 10.1016/j.otsr.2010.06.003.
Comminuted fractures of the proximal ulna are severe injuries often associated with bone and ligament injuries of the elbow joint (Monteggia lesion, radial head fractures, dislocation of the elbow). The treatment of these fractures is very demanding and the functional results often fairly mediocre due to associated injuries. Based on a single-center retrospective study, we report the results of the treatment of these fractures fixed using a double-plate technique. The aim was to evaluate the feasibility and reliability of this fixation mode and to compare it with other fractures series using a single plate fixation (in terms of bone union, elbow joint function, and complications stemming from the plates).
Eighteen patients sustained a comminuted proximal ulna fracture between 2002 and 2006. The fractures were associated in five cases with a Monteggia type lesion, in two cases with elbow dislocation, and in four cases with a Mason 3 radial head fracture. Four patients had an open fracture. These comminuted ulna fractures included nine Mayo Clinic IIIB fractures. Bone fixation was performed with two third-cylinder tubular plates, one plate on each side of the proximal ulna. This allows more versatile solutions for screw insertion. Functional assessment (according to Broberg and Morrey) and radiological evaluation (bone healing) were provided at 6 months and at the longest follow-up by an independent surgeon.
Sixteen of 18 patients achieved bone union. No septic complications occurred and no hardware removal was required on patient request. In 67% of the cases, the Morrey score indicated excellent or good results with a mean score of 82.
There are no reports in the literature on the technical point of fixation concerning complex fractures of the ulna. Two plates mean the possibility of twice the number of screw insertions for epiphyseal reconstruction . This fixation remains easy to perform and provides stable anatomic reconstruction of the ulna.
Level IV. Retrospective study.
尺骨近端粉碎性骨折是一种严重的损伤，常伴有肘关节的骨和韧带损伤（孟氏骨折、桡骨头骨折、肘关节脱位）。这些骨折的治疗要求很高，由于合并损伤，功能结果往往相当差。基于一项单中心回顾性研究，我们报告了使用双钢板技术治疗这些骨折的结果。目的是评估这种固定方式的可行性和可靠性，并将其与使用单钢板固定的其他骨折系列进行比较（在骨愈合、肘关节功能和钢板引起的并发症方面）。
18 例患者于 2002 年至 2006 年期间发生尺骨近端粉碎性骨折。其中 5 例合并孟氏骨折，2 例合并肘关节脱位，4 例合并 Mason 3 型桡骨头骨折。4 例为开放性骨折。这些粉碎性尺骨骨折包括 9 例 Mayo 诊所 IIIB 型骨折。采用两块三柱管状钢板进行骨固定，每侧一块，位于尺骨近端。这允许更灵活地选择螺钉插入方式。由一位独立的外科医生在 6 个月和最长随访时进行功能评估（根据 Broberg 和 Morrey 评估）和影像学评估（骨愈合）。
18 例患者中有 16 例达到骨愈合。无感染性并发症发生，无患者因个人要求取出内固定物。在 67%的病例中，Morrey 评分表明结果为优或良，平均评分为 82 分。
文献中没有关于尺骨复杂骨折固定技术的报道。两块钢板意味着有两倍数量的螺钉可以用于骺板重建。这种固定仍然易于操作，并能提供尺骨解剖重建的稳定性。
IV 级。回顾性研究。
