Siebenlist Sebastian, Buchholz Arne, Braun Karl F
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany.
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany.
EFORT Open Rev. 2019 Jan 7;4(1):1-9. doi: 10.1302/2058-5241.4.180022. eCollection 2019 Jan.
Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex).In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity.Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first).The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation.For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint.Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability.Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function.The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness. Cite this article: 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.
尺骨近端骨折范围从单纯的鹰嘴骨折到复杂的孟氏骨折或类孟氏损伤，后者涉及肘部稳定关键结构（即冠状突、桡骨头、侧副韧带复合体）的损伤。对于复杂骨折类型，计算机断层扫描对于准确评估损伤严重程度至关重要。精确的术前手术入路规划对于充分处理所有骨折部位（首先是冠状突基底部骨折块）至关重要。鹰嘴骨折的治疗主要包括在简单骨折中采用张力带钢丝固定作为一种有效的治疗选择，但现代钢板技术，尤其是在粉碎性或骨质疏松性骨折类型中，可减少植入物失败和潜在的与植入物相关的软组织刺激。对于孟氏损伤，尺骨对线和尺寸的精确解剖复位对于调整桡骨头关节至关重要。如果冠状突的前内侧小关节面（内侧副韧带的解剖附着点）受到影响，建议谨慎操作，以避免后内侧不稳定。在类孟氏损伤中，桡骨头重建或置换对于恢复正常肘部功能至关重要。术后康复计划应包括在手术后尽早进行无限制的主动肘部活动锻炼，以避免关节僵硬。引用本文：2019；4：1 - 9。DOI：10.1302/2058 - 5241.4.180022。
