Department of No. 2 Upper Extremity Traumatology, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2023 Aug;15(8):2033-2041. doi: 10.1111/os.13634. Epub 2023 Jan 13.
Anterolateral coronal fractures are so rare that the mechanism of injury, the type of combined fracture and ligament injury, and the optimal treatment are unknown. To study the outcome of surgical treatments for anterolateral (AL) fracture of the ulna coronoid process (Adams Type IV) and summarize the characteristics of this type of fracture and to guide clinical applications.
From February 2015 to April 2021, 32 patients were included in the study. All patients had standard radiography with anteroposterior and lateral views, computed tomography, and intraoperative fluoroscopy. All patients were treated surgically. Surgery-related information, including surgical approach, operation duration, blood loss, and repairing the lateral collateral ligament and the medial collateral ligament integrity, were recorded. The patient's clinical details, such as the final range of motion (ROM), the Broberg-Morrey scores and the visual analogue scale (VAS) at the last follow-up, were described. The chi-square test or Fisher's exact test was used for statistical analysis.
We divided patients into two groups according to the anterolateral coronoid fracture morphology. In the intact group, 20 patients with an intact anterolateral coronoid fracture fragment. In the comminuted group, 12 patients with comminuted anterolateral coronoid fracture fragments extended the less sigmoid notch of the ulna. There was no difference in age, sex, total incision length, follow-up duration, and recovery with rehabilitation among the two groups (all Ps >0.05). The other follow-up outcomes, such as elbow ROM (Flexion, Extension, Posterior rotation, Anterior rotation), VAS score, or Broberg-Morrey scores, were not different between the two groups (all Ps >0.05). Both groups achieved relatively satisfactory clinical outcomes, and the Broberg-Morrey score and index excellence rate reached 84.38%. There is a statistical difference in the history of elbow dislocation (P = 0.017), radial head fracture type (P = 0.041), operation duration (P = 0.014) and blood loss at operation (P = 0.029) between the two groups. Cannulated screws, anchors, and sutures were used as point fixation in the coronoid process of the ulna. There was a statistical difference between the two groups in the choice of internal fixation (P = 0.020).
For anterolateral ulnar coronoid fractures with different degrees of comminution, effective and reliable surgical treatment can achieve better results and fewer complications.
前外侧冠状突骨折非常罕见，其损伤机制、合并骨折类型和韧带损伤以及最佳治疗方法均不明确。本研究旨在探讨手术治疗尺骨冠状突前外侧（Adams Ⅳ型）骨折的疗效，并总结此类骨折的特点，为临床应用提供指导。
2015 年 2 月至 2021 年 4 月，共纳入 32 例患者。所有患者均接受标准前后位和侧位 X 线片、计算机断层扫描和术中透视检查。所有患者均接受手术治疗。记录手术相关信息，包括手术入路、手术时间、失血量以及外侧副韧带和内侧副韧带完整性的修复情况。描述患者的临床详细信息，如末次随访时的最终活动范围（ROM）、Broberg-Morrey 评分和视觉模拟评分（VAS）。采用卡方检验或 Fisher 确切概率法进行统计学分析。
根据前外侧冠状突骨折形态，我们将患者分为两组。在完整组中，20 例患者的前外侧冠状突骨折块完整。在粉碎组中，12 例患者的前外侧冠状突骨折块粉碎并延伸至尺骨不太明显的乙状切迹。两组在年龄、性别、总切口长度、随访时间和康复恢复方面无差异（均 P＞0.05）。两组在其他随访结果（如肘部 ROM[屈曲、伸展、后旋、前旋]、VAS 评分或 Broberg-Morrey 评分）方面无差异（均 P＞0.05）。两组均取得了较为满意的临床疗效，Broberg-Morrey 评分和指数优良率达到 84.38%。两组在肘关节脱位史（P=0.017）、桡骨头骨折类型（P=0.041）、手术时间（P=0.014）和术中出血量（P=0.029）方面存在统计学差异。尺骨冠状突采用克氏针、锚钉和缝线进行点状固定，两组内固定选择存在统计学差异（P=0.020）。
对于不同程度粉碎的尺骨冠状突前外侧骨折，有效的可靠手术治疗可获得更好的疗效和更少的并发症。
