Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Cheongra Barun Orthopaedic Center, Incheon, Republic of Korea.
J Shoulder Elbow Surg. 2021 Jul;30(7):1527-1536. doi: 10.1016/j.jse.2020.09.040. Epub 2020 Nov 4.
Fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow are classified into 3 subtypes based on their location. The purpose of this study was to analyze the fracture morphology of anteromedial facet fractures in their 3 subtypes (anteromedial rim, anteromedial rim + tip, and anteromedial rim + sublime tubercle [±tip]).
Three-dimensional computed tomography remodeling was used to evaluate anteromedial facet fractures in a consecutive series of 40 patients, all of whom were affected by posteromedial rotatory instability of the elbow. Characteristics of the fractures, including the number of fragments, size of fragments, plane of the fracture line, and involvement of the sublime tubercle and radial notch, were measured for each subtype of the anteromedial facet fractures.
Each subtype had a typical fracture pattern and distinct size. The fracture subtype 1 showed a single-fragment fracture, subtype 2 showed either a single- or dual-fragment fracture, and subtype 3 showed either a dual- or triple-fragment fracture. The angle between the fracture line and the coronal plane was greatest in subtype 3 fractures. The surface area of the fragment was largest in subtype 3 fractures. The percentages of articular involvement of the sublime tubercle were 0% in subtype 1, 47% in subtype 2, and 79% in subtype 3. The percentages of articular involvement of the radial notch were 0% in subtype 1, 7% in subtype 2, and 8% in subtype 3.
Analysis with quantitative 3-dimensional computed tomography showed the characteristic morphology of each subtype of anteromedial facet fracture. Subtype 1 comprised 1 fragment with the smallest fragment size. Subtype 2 was a single- or dual-fragment fracture, the size of which should be considered in the treatment plan. Subtype 3 was a large fragment comprising the sublime tubercle. Our findings are significant because they highlight unique fracture morphology that may help surgeons to distinguish one fracture subtype from another in clinical practice.
肘后内侧旋转不稳定中冠状突前内侧缘骨折根据其位置分为 3 个亚型。本研究旨在分析前内侧缘骨折的 3 个亚型（前内侧缘、前内侧缘+尖端和前内侧缘+小结节[±尖端]）的骨折形态。
对连续 40 例肘后内侧旋转不稳定患者进行三维 CT 重建，评估前内侧缘骨折。测量每个前内侧缘骨折亚型的骨折特征，包括碎片数量、碎片大小、骨折线平面以及小结节和桡切迹的受累情况。
每个亚型都有典型的骨折模式和明显的大小。亚型 1 为单骨折块，亚型 2 可为单或双骨折块，亚型 3 可为双或三骨折块。骨折线与冠状面的夹角在亚型 3 中最大。碎片的表面积在亚型 3 中最大。小结节关节面受累的百分比在亚型 1 中为 0%，在亚型 2 中为 47%，在亚型 3 中为 79%。桡切迹关节面受累的百分比在亚型 1 中为 0%，在亚型 2 中为 7%，在亚型 3 中为 8%。
定量三维 CT 分析显示了前内侧缘骨折各亚型的特征性形态。亚型 1 由 1 个碎片组成，碎片最小。亚型 2 为单或双骨折块，治疗方案中应考虑其大小。亚型 3 是一个包含小结节的大碎片。我们的发现具有重要意义，因为它们突出了独特的骨折形态，这可能有助于外科医生在临床实践中区分不同的骨折亚型。
