Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China.
Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China.
J Orthop Surg Res. 2019 Jul 22;14(1):230. doi: 10.1186/s13018-019-1261-3.
For coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach.
Twenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups.
The operation via the anterolateral approach took significantly shorter time than via lateral approach (p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion (p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups (p > 0.05).
Based on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.
对于肱骨小头骨冠状面剪切骨折，外侧入路是最常用的手术入路。然而，对于肱骨远端前侧的暴露范围不足。前外侧入路也已被采用以克服这一缺点。然而，由于桡神经损伤的风险，这种入路似乎在解剖上较为复杂。到目前为止，治疗小头骨冠状面剪切骨折的最佳入路仍不确定。本研究的目的是前瞻性地回顾和比较经外侧入路或前外侧入路切开复位Herbert 螺钉内固定治疗的早期临床和影像学结果。
从 2013 年 1 月至 2017 年 12 月，共纳入 26 例孤立性小头骨冠状面剪切骨折患者，随机分为外侧入路组或前外侧入路组。所有骨折均采用外侧入路或前外侧入路切开复位 Herbert 螺钉内固定治疗。比较两组患者的手术时间、伤口愈合并发症、肘关节功能和影像学证据。
前外侧入路组手术时间明显短于外侧入路组（p<0.05）。两组均无伤口愈合问题和感染。前外侧入路组有 1 例患者发生不完全性桡神经后支麻痹，4 周内完全恢复，无残留功能障碍。所有骨折均在正常解剖位置愈合，影像学检查未见异常。末次随访时，两组在旋前-旋后活动度、旋后-旋前活动度、屈伸活动度丧失或旋前-旋后活动度丧失方面无明显差异（p>0.05）。两组肘关节 MEPI 评分无明显差异（p>0.05）。
根据我们的研究结果，外侧入路和前外侧入路联合 Herbert 螺钉内固定治疗小头骨冠状面剪切骨折均具有满意的早期结果。与外侧入路相比，前外侧入路在本研究中使手术更容易且耗时更短。当滑车内侧涉及小头骨冠状骨折时，应优先选择前外侧入路。
