Department of Orthopaedic Surgery, University of Rome La Sapienza, Rome, Italy.
J Shoulder Elbow Surg. 2011 Dec;20(8):1289-99. doi: 10.1016/j.jse.2011.06.003. Epub 2011 Sep 1.
Complex fracture-dislocations of the proximal ulna and radius include multiple anatomic lesions, the management of which is known to be demanding. Although several classifications have been proposed, none appear to be exhaustive, and most of them have neither therapeutic nor prognostic value. The purpose of this study was to design a comprehensive classification that may provide a guide for the operative management of these injuries.
The classification is aimed at identifying definite anatomic lesions, called the "main lesions," the presence of which can affect the prognosis and require peculiar treatments. The main lesions include (1) ulnar fracture (including its location with respect to the insertion of collateral ligaments and coronoid fracture), (2) radiohumeral dislocation, (3) proximal radioulnar dislocation, (4) radial fracture, (5) distal radioulnar joint and interosseous membrane lesion, and (6) humeral-ulnar dislocation. Intraobserver and interobserver reliability was assessed in 25 complex fracture-dislocations. Standard radiographs and computed tomography scans were analyzed by 3 independent observers.
The main lesions were labeled by an alphanumeric system. Numbers 1 through 6 identified the type of ulnar fracture, and letters A through E indicated the dislocated joint or presence of a radial fracture. The direction of dislocation and the type of radial fracture were identified by Roman numerals, from I to III, placed after the letter. A κ value of 0.873 or greater resulted from intraobserver and interobserver evaluation.
We created a comprehensive classification of complex fracture-dislocations of the elbow. The classification appeared to be reproducible and may represent a useful tool for the management of such difficult injuries.
尺桡骨近端复杂骨折脱位包括多种解剖损伤，其处理具有挑战性。尽管已经提出了几种分类方法，但似乎都不全面，而且大多数都没有治疗或预后价值。本研究旨在设计一种全面的分类方法，为这些损伤的手术治疗提供指导。
该分类旨在确定明确的解剖损伤，称为“主要损伤”，其存在可能影响预后并需要特殊治疗。主要损伤包括：（1）尺骨骨折（包括其相对于侧副韧带和冠状突骨折的位置），（2）桡肱关节脱位，（3）近侧尺桡关节脱位，（4）桡骨骨折，（5）远侧尺桡关节和骨间膜损伤，（6）肱尺关节脱位。25 例复杂骨折脱位的观察者内和观察者间可靠性进行了评估。由 3 名独立观察者分析标准 X 线片和 CT 扫描。
主要损伤采用字母数字系统标记。数字 1 至 6 表示尺骨骨折的类型，字母 A 至 E 表示脱位关节或桡骨骨折的存在。脱位方向和桡骨骨折类型由罗马数字 I 至 III 表示，置于字母后。观察者内和观察者间评估的κ值大于 0.873。
我们创建了一种全面的肘复杂骨折脱位分类方法。该分类似乎具有可重复性，可能是处理此类困难损伤的有用工具。
