Lari Ali, Alrumaidhi Yasmen, Martinez Diego, Ahmad Amaar, Aljuwaied Hamad, Alherz Mohammad, Prada Carlos
Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait.
Hospital of the Worker of Santiago: Hospital del Trabajador de Santiago, Santiago, Chile.
Orthop Res Rev. 2024 Jun 26;16:179-197. doi: 10.2147/ORR.S472482. eCollection 2024.
Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures.
A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled.
Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%).
The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.
肱骨小头和滑车骨折，也被称为肱骨远端冠状面剪切骨折，是肘部少见但具有挑战性的关节内骨折。有多种手术入路和固定方法，其结果往往各不相同。本系统评价旨在研究肱骨小头和滑车骨折的干预措施、结果及并发症。
对发表在MEDLINE、EMBASE、科学引文索引和护理及相关健康文献累积索引（CINAHL）上的研究进行系统评价，以评估手术治疗肱骨小头和滑车骨折的临床结果。收集了患者人口统计学、手术入路、植入物使用、术后结果及并发症的数据。
41项研究符合纳入标准，共700例患者。手术干预主要采用外侧（79%）或前外侧（15%）入路，无头加压螺钉是最常用的固定方法（68%）。临床结果采用梅奥肘关节功能指数（MEPI）进行评估，平均得分为89.9（±2.6），采用上肢功能障碍评分（DASH），平均分为16.9（±7.3）。肘关节活动范围显示，平均屈曲126.3°（±19.4），伸展5.71°（±11.8），旋前75.23°（±12.2），旋后76.6°（±9.8）。平均屈伸弧为113.7°（±16.9），平均旋前旋后弧为165.31°（±9.41）。19.8%的病例发生并发症，8.3%的病例需要再次干预，主要原因是植入物出现症状以及肘关节僵硬需要手术松解。其他并发症包括取出植入物（10.4%）、总体报告的肘关节僵硬（6%）、神经麻痹（2%）、骨不连（1.5%）和感染（1.2%）。
肱骨小头和滑车骨折的治疗取得了满意的结果，但并发症和再次手术的发生率相当高，主要原因是植入物出现症状和肘关节僵硬。所达到的活动范围存在显著差异，提示结果不可预测。术后功能和活动范围不足很常见，尤其是损伤模式更复杂的情况。
