Futamura Kentaro, Tsuichida Yoshihiko, Nishida Masahiro, Hasegawa Masayuki, Suzuki Takafumi, Sato Ryo
Department of Orthopaedic Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan.
Trauma Case Rep. 2022 May 26;40:100655. doi: 10.1016/j.tcr.2022.100655. eCollection 2022 Aug.
Since the range of access of each surgical approach around the elbow has limitations, it is difficult to treat all types of fractures using only one approach. In the case reported herein, anterior and medial fragments of the comminuted ulnar coronoid process fracture were treated by preparing two access routes through one skin incision and effectively performing the buttress plating of each fragment. The subject was a 27-year-old female who sustained a fracture of the coronoid process of the right ulna by falling during snowboarding. Computed tomography showed the concurrence of a type 2 subtype III and type 3 subtype I ulnar coronoid process fracture according to the O'Driscoll classification. The coronoid process was split into 3 parts: a fragment consisting of the anteromedial facet and upper half of the sublime tubercle (fragment 1), a central fragment including the tip (fragment 2), and a fragment extending from the radial side of the tip to the base of the coronoid process (fragment 3). A 12-cm-long skin incision was made on the anteromedial side of the elbow joint. The region of the anteromedial facet and sublime tubercle was reached by passage between the palmaris longus/flexor digitorum superficialis and humeral head of flexor carpi ulnaris using the over-the-top approach. Fragment 1 was fixed with a buttress plate. Using the anterior approach, the brachialis was then longitudinally split through by passage between the biceps and neurovascular bundle, fragments 2 and 3 were fixed together with a buttress plate. The "one incision-two windows" approach, which provides two approaches (the over-the-top window and the anterior window) by a single skin incision, was implemented for a multifragmentary ulnar coronoid process fracture. This approach is considered to offer access from the front to each of the anterior and medial fragments and permits appropriate buttress plate fixation.
由于肘部周围每种手术入路的显露范围都有局限性，仅用一种入路治疗所有类型的骨折很困难。在本文报道的病例中，对于粉碎性尺骨冠状突骨折的前侧和内侧骨折块，通过一个皮肤切口制备两条入路通道，并对每个骨折块有效实施支撑钢板固定。患者为一名27岁女性，在单板滑雪时摔倒致右侧尺骨冠状突骨折。计算机断层扫描显示，根据O'Driscoll分类，为2型III亚型和3型I亚型尺骨冠状突骨折并存。冠状突被分为3部分：一个由前内侧小关节面和小结节上半部分组成的骨折块（骨折块1），一个包括尖端的中央骨折块（骨折块2），以及一个从尖端桡侧向冠状突基部延伸的骨折块（骨折块3）。在肘关节前内侧做一个12厘米长的皮肤切口。采用经肱肌入路，经掌长肌/指浅屈肌与尺侧腕屈肌肱骨头之间的间隙到达前内侧小关节面和小结节区域。用支撑钢板固定骨折块1。然后采用前入路，经肱二头肌与神经血管束之间的间隙纵向劈开肱肌，用支撑钢板将骨折块2和3固定在一起。对于多块尺骨冠状突骨折，采用“一切口双窗口”入路，即通过一个皮肤切口提供两条入路（经肱肌窗口和前窗口）。该入路被认为可从前侧显露前侧和内侧的各个骨折块，并允许进行合适的支撑钢板固定。
