Wellman David S, Lazaro Lionel E, Cymerman Rachel M, Axelrad Thomas W, Leu David, Helfet David L, Lorich Dean G
*Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; and †Department of Orthopaedic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
J Orthop Trauma. 2015 Jan;29(1):36-43. doi: 10.1097/BOT.0000000000000152.
To evaluate the outcomes of olecranon fractures treated with 2.4- and 2.7-mm plate constructs.
Retrospective Case Series.
One-level 1 trauma center and 1 tertiary care hospital.
Thirty-five consecutive patients meeting inclusion criteria.
A 2.7- or 2.4-mm reconstruction plate was placed on the dorsal ulnar cortex and contoured to allow passage of either a 2.7- or 3.5-mm intramedullary screw. In 9 patients, additional plates were required to control comminution. Available computed tomographic (CT) scans were evaluated for the presence of comminution.
Average Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo Elbow Performance Score (MEPS).
All fractures were united. Average extension deficit was 4.2 degrees, and average flexion angle was 137.4 degrees. Outcome scores were completed by 94% (33/35) of study patients. Average DASH score was 6.6, and average MEPS score was 94.5. Implants were removed in 18 patients. In the cohort of patients with CT scans, 6 of the 7 fractures thought to be simple on plain film analysis were found to have occult comminution on CT scan.
Comminution should be considered in all olecranon fractures, even when plain films display simple patterns; although this did not affect treatment in this series of plated patients, it may be important if selecting tension band wiring. Fixation with 2.4- and 2.7-mm plates addresses comminution in olecranon fractures, avoiding the pitfalls of tension band wiring. In patients with completed outcome scores, 97% (32/33) reported their outcomes as good or excellent according to the MEPS.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估采用2.4毫米和2.7毫米钢板结构治疗尺骨鹰嘴骨折的疗效。
回顾性病例系列研究。
一家一级创伤中心和一家三级护理医院。
35例符合纳入标准的连续患者。
在尺骨背侧皮质放置一块2.7毫米或2.4毫米的重建钢板，并进行塑形，以便通过一根2.7毫米或3.5毫米的髓内螺钉。9例患者需要额外的钢板来控制粉碎性骨折。对现有的计算机断层扫描（CT）进行评估，以确定是否存在粉碎性骨折。
手臂、肩部和手部功能障碍量表（DASH）平均分和梅奥肘关节功能评分（MEPS）。
所有骨折均愈合。平均伸展受限为4.2度，平均屈曲角度为137.4度。94%（33/35）的研究患者完成了疗效评分。DASH平均评分为6.6，MEPS平均评分为94.5。18例患者取出了植入物。在有CT扫描的患者队列中，在X线平片分析中被认为是简单骨折的7例骨折中，有6例在CT扫描中发现有隐匿性粉碎性骨折。
所有尺骨鹰嘴骨折均应考虑存在粉碎性骨折，即使X线平片显示为简单骨折模式；尽管在本系列钢板固定患者中这并不影响治疗，但在选择张力带钢丝固定时可能很重要。使用2.4毫米和2.7毫米钢板固定可解决尺骨鹰嘴骨折的粉碎性问题，避免张力带钢丝固定的缺陷。在完成疗效评分的患者中，97%（32/33）根据MEPS报告其疗效为良好或优秀。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
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