Lubberts Bart, Mellema Jos J, Janssen Stein J, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Arch Orthop Trauma Surg. 2017 Jan;137(1):37-42. doi: 10.1007/s00402-016-2593-7. Epub 2016 Nov 10.
The association between specific olecranon fracture characteristics (e.g., displacement, fragmentation, subluxation) and fracture line distribution might help surgeons predict intra-articular fracture location based on fracture characteristics that can be determined on radiographs. We hypothesized that fracture mapping techniques would reveal different fracture patterns for minimally displaced fractures, displaced fractures, and fracture-dislocations of the olecranon.
A consecutive series of 78 patients with olecranon fractures were evaluated using initial radiographs and computed tomography scans and characterized according to the Mayo classification. Fracture lines were identified based on reduced three-dimensional computed tomography reconstructions and graphically superimposed onto a standard template to create two-dimensional fracture maps. The fracture maps were then converted into fracture heat maps. Based on fracture and heat maps, fracture line location and patterns were determined.
Six (7.7%) patients had a non- or minimally displaced fracture, 22 (28%) a displaced fracture, and 50 (64%) a fracture-dislocation of the olecranon. There were 27 (54%) anterior and 23 (46%) posterior olecranon fracture-dislocations. Fracture lines of non- or minimally displaced fractures and posterior fracture-dislocations enter and exit the trochlear notch at the base of the coronoid, while fracture lines of displaced fractures and anterior fracture-dislocations were spread more broadly over the depths of the trochlear notch.
Based on fracture characteristics depicted on radiographs, one can anticipate the amount of the olecranon involved (how close is the fracture line to the coronoid) and the orientation of the fracture line. Computer tomography could be reserved for when more specific knowledge of the fracture line might affect treatment.
III.
特定的鹰嘴骨折特征（如移位、粉碎、半脱位）与骨折线分布之间的关联，可能有助于外科医生根据X线片上可确定的骨折特征来预测关节内骨折的位置。我们推测骨折映射技术将揭示鹰嘴无移位骨折、移位骨折和骨折脱位的不同骨折模式。
对连续78例鹰嘴骨折患者进行了初始X线片和计算机断层扫描评估，并根据梅奥分类法进行特征描述。基于三维计算机断层扫描重建图像识别骨折线，并将其图形叠加到标准模板上以创建二维骨折图。然后将骨折图转换为骨折热图。根据骨折图和热图确定骨折线的位置和模式。
6例（7.7%）患者为无移位或轻度移位骨折，22例（28%）为移位骨折，50例（64%）为鹰嘴骨折脱位。鹰嘴骨折脱位有27例（54%）为前方脱位，23例（46%）为后方脱位。无移位或轻度移位骨折以及后方骨折脱位的骨折线在冠突底部进入和穿出滑车切迹，而移位骨折和前方骨折脱位的骨折线在滑车切迹深度上分布更广泛。
根据X线片上显示的骨折特征，可以预测鹰嘴受累的范围（骨折线与冠突的距离）以及骨折线的方向。计算机断层扫描可保留用于当对骨折线有更具体的了解可能影响治疗时。
III级。
