Kekatpure Aashay L, Aminata Iman Widya, Jeon In-Ho, Rhyou In-Hyeok, Lee Hyun-Joo, Chun Jae-Myeung
Department of Orthopedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Korea.
Department of Orthopedic Surgery, Pohang Semyung Christianity Hospital, Pohang, Korea.
Indian J Orthop. 2016 May-Jun;50(3):311-5. doi: 10.4103/0019-5413.181792.
Ligamentous injury associated with isolated coronoid fracture had been sparingly reported. Concealed or unclear fractures and ligamentous or articular cartilage lesions are promptly acknowledged by magnetic resonance imaging (MRI) but cannot be entirely pictured in regular radiological assessments. In isolated coronoid fracture, the fragment size is very small and due to the complex anatomy surrounding the coronoid radiographic imaging may not be sufficient. The purpose of this study was to evaluate the incidence of combined osteochondral and ligamentous injuries by magnetic resonance imaging (MRI) in 24 patients with an isolated coronoid fracture.
In a retrospective study conducted at tertiary hospital between 2009 and 2011, elbow radiographs (anteroposterior and lateral views), computed tomography scan images, and MRI in the sagittal, coronal, axial, oblique, and coronal oblique planes were collected and reviewed. Musculoskeletal radiologist with subspecialty training in musculoskeletal MR interpretation and a fellowship-trained shoulder and elbow surgeon evaluated the MRI.
The incidence of associated injuries revealed torn lateral collateral ligament (LCL) in all 24 patients (100%) while 15 patients (62.5%) had common extensor muscle tears. Seven of 24 elbows (29.2%) showed medial collateral ligament (MCL) tear, and 13 of 16 patients (81.3%) with anteromedial facet fracture had MCL attached to the fragment. Five of 24 (20.8%) cases had contusions on the radial head. On the distal humeral side, 15 patients had bone contusions on the posterior inferior of the trochlear on sagittal view. The ligament affections of the LCL were confirmed intraoperatively and repaired.
LCL injury was consistent in all isolated coronoid fracture. The forces resulting in the injury appear similar to varus distraction forces acting in the knee leading to distraction injuries of the lateral structures of the knee joint. As concurrent osteochondral injuries and ligamentous injuries are not rare, magnetic resonance analysis serves as an excellent tool for analysis of the ligamentous injuries preoperatively and aids in surgical planning.
与单纯冠状突骨折相关的韧带损伤鲜有报道。隐匿性或不明确的骨折以及韧带或关节软骨损伤可通过磁共振成像（MRI）迅速发现，但在常规放射学评估中无法完全显示。在单纯冠状突骨折中，骨折块尺寸非常小，且由于冠状突周围解剖结构复杂，放射影像学检查可能并不充分。本研究的目的是通过磁共振成像（MRI）评估24例单纯冠状突骨折患者合并骨软骨和韧带损伤的发生率。
在一家三级医院于2009年至2011年进行的一项回顾性研究中，收集并复查了肘部X线片（前后位和侧位片）、计算机断层扫描图像以及矢状面、冠状面、轴位、斜位和冠状斜位的MRI图像。由接受过肌肉骨骼MR解读亚专业培训的肌肉骨骼放射科医生以及接受过肩肘外科 fellowship培训的医生对MRI进行评估。
相关损伤的发生率显示，所有24例患者（100%）均有外侧副韧带（LCL）撕裂，15例患者（62.5%）有伸肌总腱撕裂。24例肘部中有7例（29.2%）出现内侧副韧带（MCL）撕裂，16例前内侧关节面骨折患者中有13例（81.3%）的MCL附着于骨折块。24例中有5例（20.8%）桡骨头有挫伤。在肱骨远端，矢状位上有15例患者滑车后下部有骨挫伤。LCL的韧带损伤在术中得到证实并进行了修复。
所有单纯冠状突骨折均存在LCL损伤。导致损伤的力量似乎类似于作用于膝关节的内翻牵张力量，导致膝关节外侧结构的牵张损伤。由于并发骨软骨损伤和韧带损伤并不罕见，磁共振分析是术前分析韧带损伤的极佳工具，并有助于手术规划。
