Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey.
Department of Orthopaedics and Traumatology, Koç University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2020 Jul;54(4):364-371. doi: 10.5152/j.aott.2020.20092.
This study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate for the trochlear and distal capitellum fractures with posterior extension in the humerus.
The data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34-72) years were retrospectively evaluated. The mean follow-up period was 59.6±38.79 (22-127) months. The trochlear extension and posterior comminution of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient's opinion.
At the final follow-up, the mean elbow flexion was 137.5°±3° (132°-140°), extension was -17.9°±9.2° (10°-35°), pronation was 72.2°±2.6° (68°-75°), and supination was 78.9°±4.09 (72°-85°). The mean MEPI score was calculated as 95.5±5.98 (85-100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain score was 0.8±1.03 (0-2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered.
The management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion.
Level IV, Therapeutic study.
本研究旨在评估采用支撑钢板治疗伴有肱骨干后侧延伸的滑车和远端肱骨小头骨折的功能结果。
回顾性分析了 6 名女性和 4 名男性患者的数据，平均年龄为 43.8±11.1（34-72）岁。平均随访时间为 59.6±38.79（22-127）个月。通过初始 X 射线和计算机断层扫描图像评估滑车延伸和骨折的后侧粉碎程度。10 例患者被分类为 Dubberley 型 B。所有骨折均采用外侧支撑钢板、无头空心螺钉和克氏针（K）进行切开复位内固定治疗。术后第一天开始进行被动屈伸运动。在最后一次随访时进行临床和影像学评估。使用 Mayo 肘部功能指数（MEPI）、视觉模拟量表（VAS）疼痛评分和患者意见来量化结果。
在最后一次随访时，平均肘部屈曲为 137.5°±3°（132°-140°），伸展为-17.9°±9.2°（10°-35°），旋前为 72.2°±2.6°（68°-75°），旋后为 78.9°±4.09（72°-85°）。平均 MEPI 评分为 95.5±5.98（85-100）。根据 MEPI 评分，8 例患者评为优秀，2 例评为良好。平均 VAS 疼痛评分为 0.8±1.03（0-2）。主观患者评估结果为 5 例优秀，3 例良好，2 例中等。1 例发生缺血性坏死，2 例发生肘关节骨关节炎。1 例患者出现克氏针迁移。未发生复位丢失、不愈合、畸形愈合、反射性交感神经营养不良或异位骨化。
肱骨远端骨折的治疗具有挑战性，良好的结果与早期关节活动密切相关。牢固的固定可实现早期活动。采用外侧支撑钢板、无头空心螺钉和骨间克氏针的内固定可提供牢固可靠的结构，允许术后早期进行关节活动。
IV 级，治疗性研究。
