Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
J Shoulder Elbow Surg. 2021 Apr;30(4):942-948. doi: 10.1016/j.jse.2020.09.008. Epub 2020 Sep 30.
Fractures of the anteromedial facet (AMF) of the coronoid process are caused by a varus posteromedial rotational injury force, leading to instability in the ulnohumeral joint. AMF fractures are usually accompanied by avulsion of the lateral ulnar collateral ligament (LUCL). O'Driscoll's description and classification of AMF coronoid fractures has increased awareness and interest in this injury, but the optimal treatment has yet to be decided.
We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and Embase. The primary objective was to determine outcome scores but also complication and revision rates depending on the fracture and its therapy in order to gain a more comprehensive picture. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied.
Initially, 304 publications were identified. Finally, 10 studies were left for inclusion, all of them retrospective in design, comprising 128 patients; the majority of them were male (75.7%). A total of 114 patients (89.1%) were treated surgically and 14 patients (10.9%) were treated conservatively. Among the surgically treated patients, 70.2% were treated with LUCL refixation. The average Mayo Elbow Performance Score of the surgically treated patients was 91.5 points. The average Mayo Elbow Performance Score of the conservatively treated patients was 91.4 points. A total of 10 patients (7.8%) required reoperation.
Surgery of AMF fractures leads to a satisfactory functional outcome in the vast majority of patients independent of the subtype. An algorithm for LUCL fixation is still pending. Conservative treatment may be considered under strict preconditions, especially for nondisplaced subtype 1 and 2 fractures, as these fractures show satisfactory functional outcomes when treated nonoperatively.
前内侧关节突（AMF）骨折是由内翻后内侧旋转损伤力引起的，导致尺肱关节不稳定。AMF 骨折通常伴有外侧尺侧副韧带（LUCL）的撕脱。O'Driscoll 对 AMF 冠状突骨折的描述和分类增加了人们对这种损伤的认识和兴趣，但最佳治疗方法尚未确定。
我们系统地回顾了现有的文献，搜索了电子数据库、MEDLINE 使用 PubMed 界面和 Embase。主要目的是确定结果评分，但也取决于骨折及其治疗的并发症和翻修率，以便更全面地了解情况。应用了系统评价和荟萃分析的首选报告项目。
最初，确定了 304 篇出版物。最后，纳入了 10 项研究，均为回顾性设计，共包括 128 例患者；其中大多数为男性（75.7%）。共有 114 例（89.1%）患者接受了手术治疗，14 例（10.9%）患者接受了保守治疗。在接受手术治疗的患者中，70.2%接受了 LUCL 修复固定。手术治疗患者的平均 Mayo 肘部功能评分（MEPS）为 91.5 分。保守治疗患者的平均 Mayo 肘部功能评分（MEPS）为 91.4 分。共有 10 例（7.8%）患者需要再次手术。
AMF 骨折的手术治疗在绝大多数患者中都能获得满意的功能结果，与亚型无关。LUCL 固定的算法仍在等待中。在严格的前提下，尤其是对于无移位的 1 型和 2 型骨折，可以考虑保守治疗，因为这些骨折在非手术治疗时功能结果满意。
