Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Yonsei Wa Hospital, Incheon, Republic of Korea.
BMC Musculoskelet Disord. 2024 Jul 3;25(1):514. doi: 10.1186/s12891-024-07628-2.
PURPOSE: Comminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures. METHODS: A retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an 'on-table' reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later. RESULTS: All cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3-32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70-100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment. CONCLUSION: The on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.
目的:肱骨远端粉碎性冠状面剪力骨折较为罕见,治疗困难,尤其是粉碎性肱骨小头和滑车骨折(Dubberley Ⅲ型)。虽然在肱骨远端冠状面剪力骨折中尚未报道,但在台上进行粉碎性关节骨折重建技术可能是一种选择。本病例系列的目的是确定台上重建 Dubberley Ⅲ型骨折的功能和影像学结果。
方法:回顾性分析 2009 年 1 月至 2019 年 10 月间接受“台上”重建技术的 10 例肱骨头和滑车冠状面剪力骨折中 Dubberley Ⅲ型骨折患者。所有患者均使用手臂、肩部和手残疾(DASH)评分、美国肩肘外科医生(ASES)评分、 Mayo 肘部评分绩效指数(MEPI)评分进行评估,且随访时间至少 4 年。
结果:所有病例均获得愈合。在最终随访时,平均肘关节活动范围为 11.5°的屈曲挛缩和 131.9°的进一步屈曲。平均 DASH 评分为 21.2(5.7)分(范围 13.3-32.5)。平均 ASES 评分为 88.6±7.4(范围 77 至 100)。平均 MEPI 评分为 87(10)分(范围 70-100)。并发症方面,1 例患者发生肱骨小头部分骨坏死,1 例患者发生异位骨化但无功能障碍。
结论:台上重建技术是治疗复杂肱骨远端骨折的可靠选择。该技术可实现粉碎性肱骨小头和滑车的解剖复位,4 年随访期内发生缺血性坏死的风险较低。
证据等级:Ⅳ级,回顾性病例系列。
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