Giannicola Giuseppe, Polimanti David, Gumina Stefano, Cinotti Gianluca
Orthopedics. 2013 Oct 1;36(10):e1233-8. doi: 10.3928/01477447-20130920-12.
The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires. Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported. This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability.
冠突是提供尺肱关节稳定性的主要肘部约束结构之一。冠突骨折可用多种技术固定，包括经骨缝合、螺钉和钢板。本研究的目的是分析一系列复杂肘部不稳定患者的临床和影像学结果，这些患者的冠突骨折采用细螺纹克氏针修复。对8名男性和10名女性（平均年龄47岁）进行了平均26个月的前瞻性随访。手术治疗包括所有骨折的切开复位内固定；梅森III型损伤时行桡骨头置换；所有患者均行外侧副韧带修复；对于持续不稳定的病例，行内侧副韧带修复、应用铰链式固定器或两者兼用。根据骨折块大小，使用2根或更多细螺纹克氏针从尺骨后侧插入并采用一步固定技术将其导向冠突骨折块进行冠突固定。在最后一次随访时，平均伸展度为15°，平均屈曲度为133°，平均旋前度为78°，平均旋后度为69°；手臂、肩部和手部残疾平均评分为9.7，美国肩肘外科医师协会平均评分为85，梅奥肘关节功能评分平均为89。根据梅奥肘关节功能指数，记录到10例优、7例良和1例差的结果。除1例患者外，所有患者的肘部均稳定。除1例患者外，所有患者均观察到骨折愈合。未报告继发性冠突骨折块脱位或植入物失败。本研究表明，使用细螺纹克氏针可提供简便、微创、稳定且成功的一步固定，可用于在复杂肘部不稳定患者中实现冠突骨折的骨接合。
