Lor Kelvin Kah Ho, Toon Dong Hao, Wee Andy Teck Huat
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
Chin J Traumatol. 2019 Oct;22(5):255-260. doi: 10.1016/j.cjtee.2019.05.005. Epub 2019 Aug 9.
To assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach.
A retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS).
Twelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19-72 years). Mean follow-up was 16 months (range, 4-18 months). The average time to radiographic union was 4 months (range, 3-7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° -140°), mean elbow flexion of 134° (range, 110° -140°) and mean flexion contracture of 3° (range, 0° -20°). The mean DASH score was 16 (range, 2.5-43.8) and the mean MEPS was 75 (range, 65-100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed.
Buttress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.
评估采用内侧入路支撑钢板固定手术治疗的冠状突骨折的临床和影像学结果。
对2012年6月至2015年4月期间由资深作者在本机构采用内侧入路支撑钢板技术手术固定的所有冠状突骨折进行回顾性研究。这些骨折均为导致可怕三联征或内翻后内侧旋转不稳定损伤模式下持续肘关节不稳定的较大骨折。通过电话进行前瞻性问卷调查，使用手臂、肩部和手部功能障碍（DASH）评分和梅奥肘关节功能评分（MEPS）评估患者预后。
12例患者纳入研究，其中男性10例，女性2例，平均年龄39岁（范围19 - 72岁）。平均随访16个月（范围4 - 18个月）。平均影像学愈合时间为4个月（范围3 - 7个月）。12例患者中有11例在末次随访时获得了活动度测量结果，1例患者失访。所有11例患者肘关节功能活动度至少为30° - 130°，平均活动弧度为130°（范围110° - 140°），平均肘关节屈曲度为134°（范围110° - 140°），平均屈曲挛缩为3°（范围0° - 20°）。平均DASH评分为16（范围2.5 - 43.8），平均MEPS评分为75（范围65 - 100）。观察到的并发症包括1例浅表伤口感染患者，经口服抗生素治疗后痊愈；1例有异位骨化影像学证据的患者，采用保守治疗。未观察到残留肘关节不稳定情况，也未进行再次手术。
对于导致持续肘关节不稳定的冠状突骨折，采用内侧入路支撑钢板固定是一种可靠的治疗方法，可产生满意且可预测的结果。
