Park Sang-Min, Lee Jae Sung, Jung Jee Young, Kim Jae Yoon, Song Kwang-Sup
Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea.
J Shoulder Elbow Surg. 2015 Jan;24(1):74-82. doi: 10.1016/j.jse.2014.07.010. Epub 2014 Oct 7.
Despite an improved understanding of coronoid anteromedial facet (AMF) fractures, the optimal treatment protocol and technique have not yet been established. The goals of the study were to describe the characteristics of AMF fractures, to suggest a surgical strategy, and to report the outcomes after treatment according to this protocol.
This was a retrospective study of 19 patients with AMF fractures between 2010 and 2012. Eight patients were excluded because of secondary olecranon fracture, radial head fracture, and elbow dislocation, leaving 11 patients with isolated AMF fracture in the study cohort. There were 7 men and 4 women, with an average age of 42 years (range, 29-62 years). Fracture classification, injury pattern, and accompanying collateral ligament injury were analyzed. O'Driscoll subtype 1 fractures were treated with lateral collateral ligament (LCL) repair; O'Driscoll subtype 2 and subtype 3 fractures were treated with buttress plating and LCL repair. Plain radiographs were used to evaluate union, arthritic change, and joint articulation. Functional outcomes were evaluated with range of motion and the Mayo Elbow Performance Score.
Two patients had O'Driscoll anteromedial subtype 1 fracture, 4 patients had subtype 2, and 5 patients had subtype 3. Two patients with subtype 1 fracture had associated posterior dislocation; 9 patients with subtype 2 or subtype 3 had associated varus posteromedial injury. All 11 patients had associated LCL injury, and 6 patients had associated medial collateral ligament injury. The mean range of motion was 128°, and the average Mayo Elbow Performance Score was 89 points. Qualitatively, patient outcomes were scored excellent in 4 patients, good in 6 patients, and fair in 1 patient.
AMF fractures are almost always accompanied by collateral ligament injuries. Thus, our surgical strategies, which include collateral ligament repair, are able to stabilize and result in favorable clinical outcomes. On the basis of our results, we recommend LCL repair alone for subtype 1 fractures and buttress plating and LCL repair for subtype 2 and subtype 3 fractures.
尽管对冠状突前内侧小关节面（AMF）骨折的认识有所提高，但尚未确定最佳的治疗方案和技术。本研究的目的是描述AMF骨折的特征，提出一种手术策略，并报告根据该方案治疗后的结果。
这是一项对2010年至2012年间19例AMF骨折患者的回顾性研究。8例患者因继发鹰嘴骨折、桡骨头骨折和肘关节脱位被排除，研究队列中剩下11例孤立的AMF骨折患者。其中男性7例，女性4例，平均年龄42岁（范围29 - 62岁）。分析骨折分类、损伤模式及伴发的侧副韧带损伤情况。O'Driscoll 1型骨折采用外侧副韧带（LCL）修复；O'Driscoll 2型和3型骨折采用支撑钢板固定及LCL修复。通过X线平片评估骨折愈合、关节炎改变及关节对位情况。采用活动范围和梅奥肘关节功能评分评估功能结果。
2例患者为O'Driscoll前内侧1型骨折，4例为2型，5例为3型。2例1型骨折患者伴有后脱位；9例2型或3型骨折患者伴有内翻后内侧损伤。所有11例患者均伴有LCL损伤，6例患者伴有内侧副韧带损伤。平均活动范围为128°，平均梅奥肘关节功能评分为89分。定性评估，4例患者结果为优，6例为良，1例为可。
AMF骨折几乎总是伴有侧副韧带损伤。因此，我们包括侧副韧带修复的手术策略能够稳定骨折并取得良好的临床效果。基于我们的结果，我们推荐1型骨折单独行LCL修复，2型和3型骨折行支撑钢板固定及LCL修复。
