Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy.
Eur J Orthop Surg Traumatol. 2022 Oct;32(7):1341-1356. doi: 10.1007/s00590-021-03113-x. Epub 2021 Sep 12.
Epicondyle involvement in capitellar and trochlear fractures is often considered a simple associated lesion that does not substantially change treatment or prognosis. Although theoretically predicted in reviews, case series almost never report elbow prosthesis use in comminuted coronal shear injuries associated with epicondylar fracture in the elderly. The purpose of this study is to focus on this underestimated injury pattern that can be a negative risk factor for treatment and prognosis.
We retrospectively reviewed all cases with coronal shear fracture of the distal humerus treated from 2016 to 2019. Fractures were classified according to Dubberley. Open reduction and internal fixation (ORIF) were performed when possible. Partial or total elbow replacement was used in severely comminuted fractures with epicondylar involvement in four elderly patients.
Nineteen consecutive patients were selected (mean age: 62.4 years), of which 10 had type 3A/3B fractures, and seven had both medial and lateral epicondylar involvement. The mean follow-up duration was 31.78 months. The average Mayo Elbow Performance Index (MEPI) score was 81.05 points, with 7 excellent, 8 good, 1 fair, and 3 poor results. The average MEPI score of Dubberley's type 1 and type 2 was better than that of type 3 (mean: 92 vs. 72, p = 0.02). Further, the results of average range of motion were better in patients who had sustained Dubberley types 1 and 2 lesions than those with Dubberley type 3 lesion (mean: 133° vs. 85°, p = 0.002). Two patients out of three who required intra-operative conversion to total elbow arthroplasty had poor outcomes.
The simultaneous presence of fracture of one or both epicondyles are usually associated with severe joint comminutions and makes ORIF more challenging, especially among elderly women. In these cases, primary total elbow prosthesis implantation could be a valid treatment option.
尺骨突和滑车骨折中累及肱骨外上髁被认为是一种简单的伴随损伤，不会显著改变治疗或预后。尽管在综述中理论上有预测，但病例系列几乎从未报告过在老年人伴有肱骨外上髁骨折的粉碎性冠状面剪力损伤中使用肘假体。本研究的目的是关注这种被低估的损伤模式，它可能是治疗和预后的一个负面危险因素。
我们回顾性分析了 2016 年至 2019 年期间收治的所有伴有肱骨远端冠状面剪力骨折的病例。骨折按 Dubberley 分类。如果可能，进行切开复位内固定（ORIF）。对于伴有肱骨外上髁累及的严重粉碎性骨折，4 例老年患者采用部分或全肘置换。
共选择了 19 例连续患者（平均年龄：62.4 岁），其中 10 例为 3A/3B 型骨折，7 例为内外侧肱骨外上髁均受累。平均随访时间为 31.78 个月。平均 Mayo 肘功能评分（MEPI）为 81.05 分，7 例优，8 例良，1 例可，3 例差。Dubberley 1 型和 2 型的平均 MEPI 评分优于 3 型（平均：92 分比 72 分，p=0.02）。此外，Dubberley 1 型和 2 型患者的平均活动范围优于 Dubberley 3 型患者（平均：133°比 85°，p=0.002）。3 例需要术中转为全肘置换的患者中，有 2 例预后较差。
单一或双侧肱骨外上髁骨折的同时存在通常与严重的关节粉碎有关，使 ORIF 更具挑战性，尤其是在老年女性中。在这些情况下，初次全肘假体植入可能是一种有效的治疗选择。
