1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):314-318. doi: 10.1007/s00167-018-4926-2. Epub 2018 Apr 2.
Arthroscopic reduction and internal fixation for coronoid process fractures has been proposed to overcome limitations of open approaches. Currently, arthroscopy is most frequently used to assist insertion of a retrograde guide wire for a retrograde cannulated screw. The present anatomical study presents an innovative arthroscopic technique to introduce an antegrade guide wire from an accessory anteromedial portal and evaluates its safety and reproducibility.
Six fresh-frozen cadaver specimens were obtained and prepared to mimic an arthroscopic setting. The coronoid process was localized and a 0.9 mm Kirschner wire was introduced from an accessory anteromedial portal, located 2 cm proximal to the standard anteromedial portal. At the end of the procedure, a lateral radiograph was taken to verify the Kirschner wire position and open dissection was conducted to evaluate possible damage to neurovascular structures.
The Kirschner wire was drilled without complications in the coronoid process of all six specimens. Damage of the brachial artery, the median nerve, and the ulnar nerve did not occur in any specimen. A corridor between the brachialis muscle, the median intermuscular septum, and the pronator teres could be identified as suitable for the wire passage.
This study presents a safe and reproducible technique combining the possibility to introduce a guide wire from the anteromedial part of the coronoid, under direct visual control, with a completely arthroscopic approach. This wire can guide the introduction of a retrograde cannulated screw from the dorsolateral ulna to the tip of the coronoid. This new arthroscopic approach permits to obtain improved visual control over coronoid process fixation, without endangering neurovascular structures.
关节镜下复位和内固定治疗冠状突骨折，旨在克服开放入路的局限性。目前，关节镜最常用于辅助逆行导丝插入逆行空心螺钉。本解剖研究提出了一种创新的关节镜技术，从辅助前内侧入路引入顺行导丝，并评估其安全性和可重复性。
获得 6 个新鲜冷冻尸体标本并进行准备，以模拟关节镜设置。定位冠状突，并从位于标准前内侧入路 2cm 近端的辅助前内侧入路引入 0.9mm 的克氏针。在手术结束时，拍摄侧位 X 线片以验证克氏针的位置，并进行开放性解剖以评估对神经血管结构的可能损伤。
在所有 6 个标本的冠状突中，克氏针均顺利钻入，无并发症。在任何标本中均未发生肱动脉、正中神经和尺神经损伤。可以识别出肱肌、正中肌间隔和旋前圆肌之间的通道，适合导丝通过。
本研究提出了一种安全且可重复的技术，结合了从前内侧冠状突部分直接可视控制下引入导丝的可能性，以及完全关节镜入路。该导丝可引导逆行空心螺钉从尺骨背外侧向冠状突尖端插入。这种新的关节镜入路可在不危及神经血管结构的情况下，获得对冠状突固定的更好的可视控制。
