Department for Trauma Surgery and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Germany.
Injury. 2012 Mar;43(3):295-300. doi: 10.1016/j.injury.2011.06.418. Epub 2011 Jul 22.
Distal humerus fractures are rare and challenging to treat. Anatomic reduction of the articular surface and stable osteosynthesis are mandatory for satisfactory results. The transolecranon approach allows superior visualisation of the joint. However, controversy exists regarding how best to fix the osteotomy. The purpose of the present study was to investigate the eligibility of a one-third tubular hook plate for osteosynthesis of olecranon osteotomies in distal humerus type-C fractures.
A consecutive series of 34 patients who were treated through an olecranon osteotomy and underwent fixation using a one-third tubular hook plate were identified. Thirty-one patients (17 females, 14 males) with a median age of 50 years (14-87, standard deviation (SD) 18.3) were available for a comprehensive assessment after a mean of 12.3 months (6-20, SD 3.7). Using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, six (19.4%) fractures were categorised as type C2 and 25 (80.6%) were categorised as C3. Physical and radiological examinations were performed. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand score (DASH) were evaluated.
Mean extension-flexion ROM was found to be 102° (50-145°, SD 25). Pronation and supination were only slightly compromised. The mean MEPS was 87.2 points (50-100, SD 12.4). Fourteen patients (45.2%) were rated as excellent, and 15 (48.4%) were rated as good. One patient was rated fair, and one patient was rated as poor, respectively. Mean DASH score was 24.4 points (0-65, SD 20.3). Complications regarding the osteotomy occurred in seven patients (22.5%). Revision surgery was necessary in five cases (16%). At follow-up, all osteotomies went on to union. Mild joint degeneration (Broberg I) was found in 10 patients (32.2%). Implant removal was carried out in 15 patients (48.4%).
Based on this study, the osteosynthesis of olecranon osteotomies using a one-third tubular hook plate can be regarded as a safe procedure with a low complication rate. The implant needed is widely available and cost-efficient, in contrast to specially designed plates or nails.
肱骨远端骨折较为少见，治疗难度较大。为了获得满意的疗效，需要解剖复位关节面并稳定固定。经鹰嘴截骨入路可更好地显露关节，但关于如何最好地固定截骨块仍存在争议。本研究旨在探讨三分之一管状钩钢板固定肱骨远端 C 型骨折鹰嘴截骨的可行性。
我们连续纳入了 34 例接受鹰嘴截骨并采用三分之一管状钩钢板固定的患者。31 例患者（17 名女性，14 名男性），平均年龄 50 岁（14-87 岁，标准差 18.3 岁），平均随访 12.3 个月（6-20 个月，标准差 3.7 个月）后接受了全面评估。根据 Arbeitsgemeinschaft für Osteosynthesefragen（AO）骨折分型，6 例（19.4%）为 C2 型骨折，25 例（80.6%）为 C3 型骨折。对患者进行体格检查和影像学检查，采用 Mayo 肘关节功能评分（MEPS）和上肢残障评分（DASH）评估患者的功能。
平均屈伸活动度为 102°（50-145°，标准差 25°）。旋前和旋后功能仅受到轻微影响。平均 MEPS 评分为 87.2 分（50-100 分，标准差 12.4 分）。14 例（45.2%）患者被评为优，15 例（48.4%）患者被评为良。1 例患者被评为可，1 例患者被评为差。平均 DASH 评分为 24.4 分（0-65 分，标准差 20.3 分）。7 例（22.5%）患者发生鹰嘴截骨相关并发症，其中 5 例（16%）需要翻修手术。随访时所有截骨均愈合，10 例（32.2%）患者出现轻度关节退变（Broberg Ⅰ型）。15 例（48.4%）患者取出了内固定物。
本研究表明，采用三分之一管状钩钢板固定鹰嘴截骨是一种安全的手术方法，并发症发生率低。该内固定物应用广泛，成本效益高，与特制钢板或螺钉相比具有优势。
