Lopiz Yaiza, Rodríguez-González Alberto, García-Fernández Carlos, Marco Fernando
Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain.
Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain.
J Shoulder Elbow Surg. 2016 Mar;25(3):369-75. doi: 10.1016/j.jse.2015.12.004.
The aim of this study was to describe the fracture patterns of capitellum coronal fractures and to evaluate the complications and functional and radiographic outcomes of open reduction and internal fixation in patients older than 65 years.
A retrospective study of 23 patients with a mean follow-up of 48 months (36-105) was performed. Fractures were classified according to the Dubberley classification. All patients were evaluated by the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores.
Three patients were lost to follow-up. There were 16 type 1 and 4 type 2 fractures. The mean age was 71 years (66-79), and 65% were women. The mean MEPI score was 92 (60-100), and the mean DASH score was 9 (0-75). Either a concomitant fracture or an elbow dislocation was present in 50% of the patients. Mean sagittal plane range of motion at last follow-up was 122° ± 8°, with lower extension in type 2 and worse scores on MEPI (91 vs. 97) and DASH (3 vs. 0) scales. Placement of the screws in the posteroanterior direction was associated with better range of motion in flexion (130° vs. 122°) and better outcomes in functional scores (MEPI, 97 vs. 89; QuickDASH, 0 vs. 4). Complications were post-traumatic osteoarthritis in 3 patients, avascular necrosis in 1 patient, and heterotopic ossification in 5 patients. One patient required reoperation.
Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. Open reduction and internal fixation with cannulated screws allow stable fixation and provide satisfactory functional results with a lower complication rate.
本研究的目的是描述肱骨小头冠状面骨折的骨折类型，并评估65岁以上患者切开复位内固定术的并发症、功能及影像学结果。
对23例患者进行回顾性研究，平均随访48个月（36 - 105个月）。骨折根据Dubberley分类法进行分类。所有患者均采用梅奥肘关节功能指数（MEPI）及上肢、肩部和手部功能障碍（DASH）评分进行评估。
3例患者失访。有16例1型骨折和4例2型骨折。平均年龄为71岁（66 - 79岁），65%为女性。平均MEPI评分为92分（60 - 100分），平均DASH评分为9分（0 - 75分）。50%的患者存在合并骨折或肘关节脱位。末次随访时矢状面平均活动范围为122°±8°，2型骨折伸展度较低，MEPI（91分对97分）和DASH（3分对0分）评分较差。螺钉从前向后置入与更好的屈曲活动范围（130°对122°）及更好的功能评分结果（MEPI，97分对89分；QuickDASH，0分对4分）相关。并发症包括3例创伤后骨关节炎、1例缺血性坏死和5例异位骨化。1例患者需要再次手术。
65岁以上患者发生复杂骨折类型的风险不大，但合并损伤较多。空心螺钉切开复位内固定可实现稳定固定，并发症发生率较低，功能结果满意。
