Arrigoni Paolo, Archinà Martina, Luceri Francesco, Radici Mattia, Zaolino Carlo, Folco Gianluca, Foschini Chiara, Regazzoni Simona, Miano Paul Muriithi, Zagarella Andrea, Colozza Alessandra, Randelli Pietro
U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy.
Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
J Exp Orthop. 2023 Mar 15;10(1):25. doi: 10.1186/s40634-023-00571-6.
Traumatic elbow dislocation is the second most frequent joint dislocation, even though the elbow is a congruent and stable joint. Individual variability in anatomical congruence of the elbow and how it relates to simple or complex instability has rarely been studied in the literature; we hypothesized that a greater articular coverage by the humeral trochlea would be more likely to result in complex dislocation. The aim of this study is to analyze trochlear morphology in simple (SED) and complex elbow dislocation (CED), to assess whether the degree of humeroulnar joint congruence influences the incidence of coronoid fractures in elbow dislocation. The secondary goal is to evaluate the association between trochlear morphology and coronoid fracture pattern.
All the elbow CT scans of the hospital server were retrospectively analyzed. 62 patients were enrolled and so divided in 2 groups: SED and CED with isolated coronoid fracture. Patients who were skeletally immature, presented with other concomitant elbow fractures, or who previously underwent elbow surgery were excluded. The CT scans were performed after closed reduction and prior to further treatment. Coronoid fracture pattern was classified on CT scan according to Regan-Morrey and O'Driscoll classifications; "grade 0" was assigned to SED. Trochlear coverage was measured and expressed as three angles (anterior, posterior, and distal) and their width/depth ratios. Measurements were taken by four different readers and the assessment was repeated after 15 days.
No statistically significant difference was found between humeral trochlear morphology of SED and CED patients. There was no association between morphometric measurements and coronoid fracture pattern. The results are strengthened by a good intra- and inter-reader reproducibility of the CT analysis protocol.
Our study is the first to evaluate the impact of trochlear morphology on elbow instability. Considering the results, other variables may have a greater impact on coronoid bone damage, such as trauma energy or ligamentous hyperlaxity: in particular, we believe that the capsuloligamentous structures of the elbow might contribute in a preponderant way to articular stability. The CT analysis protocol gave excellent results: reproducible, accurate and easy to perform.
III.
创伤性肘关节脱位是第二常见的关节脱位，尽管肘关节是一个匹配且稳定的关节。肘关节解剖匹配的个体差异及其与简单或复杂不稳定的关系在文献中很少被研究；我们假设肱骨滑车的关节覆盖范围更大更有可能导致复杂脱位。本研究的目的是分析简单肘关节脱位（SED）和复杂肘关节脱位（CED）中的滑车形态，评估肱尺关节匹配程度是否影响肘关节脱位时冠状突骨折的发生率。次要目标是评估滑车形态与冠状突骨折类型之间的关联。
对医院服务器中的所有肘关节CT扫描进行回顾性分析。纳入62例患者，并将其分为2组：单纯SED组和伴有孤立冠状突骨折的CED组。排除骨骼未成熟、伴有其他肘关节骨折或既往接受过肘关节手术的患者。CT扫描在闭合复位后且进一步治疗前进行。根据Regan - Morrey和O'Driscoll分类法在CT扫描上对冠状突骨折类型进行分类；SED组为“0级”。测量滑车覆盖范围并表示为三个角度（前、后和远端）及其宽度/深度比。由四名不同的阅片者进行测量，并在15天后重复评估。
SED组和CED组患者的肱骨滑车形态之间未发现统计学上的显著差异。形态学测量与冠状突骨折类型之间无关联。CT分析方案良好的阅片者内和阅片者间可重复性加强了研究结果。
我们的研究首次评估了滑车形态对肘关节不稳定的影响。考虑到研究结果，其他变量可能对冠状突骨损伤有更大影响，如创伤能量或韧带过度松弛：特别是，我们认为肘关节的关节囊韧带结构可能对关节稳定性起主要作用。CT分析方案取得了优异的结果：可重复、准确且易于实施。
III级。
