Chen Alvin Chao-Yu, Weng Chun-Jui, Chou Ying-Chao, Cheng Chun-Ying
Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou & University College of Medicine, 5th, Fu-Shin St., Kweishan District, Taoyuan, 333, Taiwan, Republic of China.
BMC Musculoskelet Disord. 2018 Jul 23;19(1):248. doi: 10.1186/s12891-018-2162-z.
This study aimed to report the radiographic findings and surgical outcomes of anteromedial facet (AMF) fracture of the ulnar coronoid process and to suggest an optimal approach.
In this retrospective study, 20 consecutive patients with unilateral AMF fracture of coronoid process were surgically treated and divided into two groups without (group A) and with (group B) additional proximal ulnar fractures in equal case number. Time from injury to surgery averaged 4.38 ± 2.56 weeks. Mayo Elbow Performance Score (MEPS) and Shortened Disability of the Arm and Shoulder and Hand (quickDASH) score were used for functional evaluation. Cohen kappa coefficient (kappa) analysis was used to determine interobserver reliability on a radiographic reading.
All cases had a mean follow-up of 2.3 years. MEPS at 2 years averaged 87.75 ± 12.51; quickDASH, 7.05 ± 6.19. A significantly higher MEPS was found in subtype 3 than in subtype 2 (p = 0.036) and in group B than in group A (p = 0.020). Significantly lower quickDASH cores were found in group B than in group A (p = 0.011). Kappa analysis showed moderate agreement in the O'Driscoll classification (kappa = 0.56) and substantial agreement in categorization of the additional proximal ulnar fractures (kappa = 0.76).
Additional proximal ulnar lesions were considered an integral part of varus posteromedial rotatory instability and required further categorization in the management of AMF fractures. Significantly better functional outcomes were achieved when those lesions were fully addressed.
本研究旨在报告尺骨冠状突前内侧小面（AMF）骨折的影像学表现及手术结果，并提出最佳手术方法。
在这项回顾性研究中，对20例连续的单侧冠状突AMF骨折患者进行了手术治疗，并将其分为两组，每组病例数相等，其中一组（A组）无尺骨近端附加骨折，另一组（B组）有尺骨近端附加骨折。受伤至手术的平均时间为4.38±2.56周。采用梅奥肘关节功能评分（MEPS）和上肢、肩部与手部简化功能障碍评分（quickDASH）进行功能评估。采用科恩kappa系数（kappa）分析来确定影像学读片的观察者间可靠性。
所有病例的平均随访时间为2.3年。2年时MEPS平均为87.75±12.51；quickDASH平均为7.05±6.19。3型患者的MEPS显著高于2型患者（p = 0.036），B组患者的MEPS显著高于A组患者（p = 0.020）。B组患者的quickDASH评分显著低于A组患者（p = 0.011）。kappa分析显示，在O'Driscoll分类中一致性中等（kappa = 0.56），在尺骨近端附加骨折的分类中一致性较高（kappa = 0.76）。
尺骨近端附加损伤被认为是内翻后内侧旋转不稳定的一个组成部分，在AMF骨折的治疗中需要进一步分类。当这些损伤得到充分处理时，可获得显著更好的功能结果。
