Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau GGmbH, Am Hasenkopf 1, Aschaffenburg, Germany.
Center for Orthopaedics and Trauma Surgery, Leipzig, Germany.
Chin J Traumatol. 2022 Nov;25(6):336-344. doi: 10.1016/j.cjtee.2022.03.001. Epub 2022 Mar 9.
Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail® (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed.
This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel® 2016.
There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supination. Twenty-five patients reported being pain-free under all circumstances, and all but 2 patients (93.75%) had returned to their previous activity level. The average disabilities of the arm, shoulder and hand score was 21.15 (range 0-88.3), and the overall Mayo elbow performance index was 91.87, without complications, such as wound infection, neurovascular impairment or premature hardware removal.
Using the XS nail® system, all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature. An excellent functional outcome, high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.
尺骨鹰嘴骨折特别容易发生移位和随后的骨折脱位，这是由于高拉伸力所致。手术治疗的目的是减少骨折并恢复解剖关节面状况，以及中和抑制骨折愈合的应变。XS 钉®（Intercus GmbH，Bad Blankenberg，德国）是一种髓内植入物，与钢板不同，它可以在整个骨折面上施加压缩力，在皮质外留下最小的轮廓，并可以用螺纹锁定线固定，从而保持解剖复位，不会在关节面内发生移位或台阶，这在张力带固定术中经常发生。在取得令人鼓舞的初步结果后，评估了长期结果。
本回顾性研究评估了 2002 年 1 月至 2005 年 12 月期间在我们创伤中心接受 XS 钉®手术治疗的患者的长期结果。符合研究条件的年龄在 18 岁以上的患者必须接受过手术治疗，且为最近（<14 天）外伤性尺骨鹰嘴骨折，同侧肘部和前臂无其他合并伤。进一步排除标准为假关节、再骨折和肱骨远端切开术、以及无法自行康复的多发伤患者。数据通过标准化问卷和患者记录以及手术和麻醉报告进行回顾性收集。数据分析使用 Microsoft Office Excel®2016 进行。
共有 32 名患者，13 名男性（平均年龄 49.0 岁）和 19 名女性（平均年龄 68.9 岁），其中 11 例为 Schatzker 型 D，7 例为 A 型和 C 型，5 例为 B 型和 2 例为 E 型，平均随访时间为 55.2 个月，所有患者均完全愈合。其中 6 例患者矢状面活动度丧失超过 10°，仅有 1 例患者旋前减少超过 10°。25 例患者在所有情况下均无疼痛，除 2 例患者（93.75%）外，所有患者均恢复到之前的活动水平。手臂、肩部和手部残疾评分平均为 21.15（范围 0-88.3），总体 Mayo 肘部功能指数为 91.87，无并发症，如伤口感染、神经血管损伤或过早去除内固定物。
使用 XS 钉®系统可以成功治疗所有骨折类型，并发症发生率低于目前文献中标准方法治疗的并发症发生率。极佳的功能结果、高活动度以及良好的复位保持，而不会刺激软组织，这使得该植入物非常适合张力性骨折。
