Wang Xin, Chang Shi-Min, Yu Guang-Rong
Department of Orthopaedic Surgery of Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Eur J Orthop Surg Traumatol. 2013 Apr;23(3):251-5. doi: 10.1007/s00590-012-0990-3. Epub 2012 Apr 12.
The anteromedial coronoid facet and the medial lip of trochlea represent one of the most important stabilizing columns of the elbow to prevent posterior dislocation of the elbow. But on average, 58 % of the anteromedial facet extends from the proximal ulnar without sufficient support by the proximal ulnar metaphysic. Some important soft tissue structures insert on the coronoid process. The fracture of anteromedial coronoid facet was recognized recently in clinic as a distinct type of the coronoid fracture. The special injury mechanism is varus posteromedial rotational injury force. This mechanism results in fracture of the anteromedial facet of the coronoid process most often associated with injury of the lateral collateral ligament (LCL) and either subluxation or complete dislocation of the elbow. But the anterior band of the medial collateral ligament is likely to be intact in the complex pattern injury. Standard radiographic evaluation of the fracture includes AP and lateral views of the elbow. Computed tomography, particularly 3D reconstruction, is particularly useful to diagnose the injury. But the LCL injury is easy to be missed, resulting in an earlier traumatic arthrosis. So, it is very important to increase recognition to the pattern injury. If the single distinct converse triangular fragment be found from the film, the surgeon should take care highly, and varus stress x-ray should be necessary to evaluate the LCL injury. Early experience suggests that the injuries should benefit from operative treatment. All injured structures should be repaired to restore the stability of the elbow. Intraoperative testing of the elbow stability is very important.
冠突前内侧小关节面和滑车内侧唇是防止肘关节后脱位的最重要稳定柱之一。但平均而言，58%的前内侧小关节面从尺骨近端延伸，而没有近端尺骨干骺端的足够支撑。一些重要的软组织结构附着于冠突。冠突前内侧小关节面骨折在临床上最近被认为是一种独特类型的冠突骨折。其特殊的损伤机制是内翻后内侧旋转暴力。这种机制导致冠突前内侧小关节面骨折，最常伴有外侧副韧带（LCL）损伤以及肘关节半脱位或完全脱位。但在这种复杂类型损伤中，内侧副韧带前束可能保持完整。骨折的标准影像学评估包括肘关节正位和侧位片。计算机断层扫描，尤其是三维重建，对诊断该损伤特别有用。但LCL损伤很容易被漏诊，从而导致早期创伤性关节炎。因此，提高对这种类型损伤的认识非常重要。如果在片子上发现单个明显的倒三角形碎片，外科医生应高度重视，并且需要进行内翻应力X线检查以评估LCL损伤。早期经验表明，这些损伤手术治疗可能有益。所有损伤结构均应修复以恢复肘关节稳定性。术中对肘关节稳定性进行测试非常重要。
