Brule Nick, Ozdag Yagiz, Koshinski Jessica L, Luciani A Michael, Grandizio Louis C
Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA.
Division of Hand and Upper-Extremity Surgery, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger MSKI, Scranton, PA.
J Hand Surg Am. 2025 Jul;50(7):886.e1-886.e12. doi: 10.1016/j.jhsa.2024.06.003. Epub 2024 Jul 10.
Traumatic elbow instability (subluxation and dislocation) represents a challenging clinical entity that can be complicated by persistent intraoperative instability after attempted stabilization or recurrent postoperative instability. Both static and dynamic supplemental stabilization procedures have been described for cases where fracture fixation and ligament repair fail to restore stability. There is a paucity of prior studies involving ulnohumeral cross-pinning (UCP), which is a type of static supplemental stabilization. Our purpose was to assess complications and outcomes after UCP.
We reviewed all surgical cases involving primary and revision UCP for traumatic elbow instability at a single center from 2017-2023. Baseline demographics were recorded. Outcomes including radiographs, range of motion, patient-reported outcome measures, and surgical complications were analyzed.
Fourteen patients undergoing UCP were included with a mean follow-up of 27 months. Five cross-pinnings (36%) were performed during revision procedures. Mean visual analog scale (VAS) pain, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Single Assessment Numeric Evaluation (SANE) scores were 2.4, 34, and 69, respectively. The mean flexion-extension and pronation-supination arcs were 114° and 140°, with 85% achieving at least a 100° arc for flexion and forearm rotation. Five patients (36%) had complications, all of which required reoperation. Two complications involved postoperative instability: one radial head subluxation and one radial head dislocation. Both occurred in revision UCP cases indicated for recurrent postoperative instability.
Ulnohumeral cross-pinning for persistent and recurrent elbow instability results in maintained ulnohumeral joint alignment, functional arcs of elbow range of motion, and acceptable patient-reported outcome measures, particularly in the setting of a primary procedure indicated for persistent intraoperative instability. Ulnohumeral cross-pinning is a reasonable supplemental stabilization procedure for complex elbow instability.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
创伤性肘关节不稳定（半脱位和脱位）是一种具有挑战性的临床病症，在尝试进行稳定治疗后可能会出现术中持续不稳定或术后反复不稳定的并发症。对于骨折固定和韧带修复未能恢复稳定性的病例，已经描述了静态和动态补充稳定手术。此前涉及尺肱交叉穿针固定术（UCP）的研究较少，UCP是一种静态补充稳定手术。我们的目的是评估UCP术后的并发症和结果。
我们回顾了2017年至2023年在单一中心进行的所有涉及原发性和翻修性UCP治疗创伤性肘关节不稳定的手术病例。记录基线人口统计学数据。分析包括X线片、活动范围、患者报告的结局指标和手术并发症等结果。
纳入14例行UCP手术的患者，平均随访27个月。5例（36%）交叉穿针固定术在翻修手术中进行。视觉模拟量表（VAS）疼痛评分、上肢、肩部和手部功能障碍（QuickDASH）评分以及单项评估数字评价（SANE）评分的平均值分别为2.4、34和69。屈伸和旋前旋后弧度的平均值分别为114°和140°，85%的患者屈伸弧度和前臂旋转弧度至少达到100°。5例患者（36%）出现并发症，所有并发症均需再次手术。2例并发症涉及术后不稳定：1例桡骨头半脱位和1例桡骨头脱位。两者均发生在因术后反复不稳定而进行翻修UCP手术的病例中。
尺肱交叉穿针固定术用于治疗持续性和复发性肘关节不稳定，可维持尺肱关节对线、肘关节活动范围的功能弧度，并使患者报告的结局指标达到可接受水平，特别是在针对术中持续不稳定进行初次手术的情况下。尺肱交叉穿针固定术是治疗复杂肘关节不稳定的一种合理的补充稳定手术。
研究类型/证据水平：治疗性IV级。
