Ayala Alfonso E, Kim Kelvin, Romero Brandon A, Kam Galen S
Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA.
Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA.
J Shoulder Elbow Surg. 2023 Dec;32(12):2590-2598. doi: 10.1016/j.jse.2023.06.005. Epub 2023 Jul 7.
The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries.
Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics.
A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up.
This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.
博伊德入路是一种单切口后入路，用于桡骨近端和尺骨，基于外侧肘肌的牵开以及外侧副韧带复合体的松解。在早期有关于近端桡尺关节融合和术后肘关节不稳的报道后，该入路一直是一种较少使用的技术。尽管受小病例系列的限制，但近期文献并不支持这些早期报道的并发症。本研究展示了一位外科医生使用博伊德入路治疗简单至复杂肘关节损伤的结果。
经机构审查委员会批准，对2016年至2020年期间由一位肩肘外科医生连续使用博伊德入路治疗的所有简单至复杂肘关节损伤患者进行回顾性研究。纳入所有至少有1次术后门诊随访的患者。收集的数据包括患者人口统计学资料、损伤描述、术后并发症、肘关节活动范围以及影像学检查结果，包括异位骨化和近端桡尺关节融合。分类变量和连续变量采用描述性统计进行报告。
共纳入44例患者，平均年龄49岁（范围13 - 82岁）。最常治疗的损伤是孟氏骨折脱位（32%）和可怕三联征损伤（18%）。平均随访时间为8个月（范围1 - 24个月）。最终肘关节平均主动活动弧从伸展20°（范围0° - 70°）至屈曲124°（范围75° - 150°）。最终旋后和旋前分别为53°（范围0° - 80°）和66°（范围0° - 90°）。没有近端桡尺关节融合的病例。2例（5%）选择保守治疗的患者出现异位骨化，导致肘关节功能活动范围减小。有1例（2%）因损伤韧带修复失败导致术后早期后外侧不稳，需要采用韧带增强手术进行翻修。5例（11%）患者出现术后神经病变，其中4例（9%）为尺神经病变。其中，1例接受了尺神经转位手术，2例病情好转，1例在最终随访时仍有持续症状。
这是现有最大的病例系列，证明了博伊德入路在治疗简单至复杂肘关节损伤中的安全应用。包括关节融合和肘关节不稳在内的术后并发症可能不像之前认为的那么常见。
