Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2024 Nov;33(11):e610-e615. doi: 10.1016/j.jse.2024.05.024. Epub 2024 Jul 15.
Trans-ulnar fracture-dislocations of the elbow are complex injuries that can be difficult to classify and treat. Trans-ulnar basal coronoid injuries, in which the coronoid is not attached to either the olecranon or the metaphysis, present substantial challenges to achieve anatomic reduction and stable internal fixation. The purpose of this study was to analyze the outcome of surgical treatment of trans-ulnar basal coronoid fracture-dislocations.
Between 2002 and 2019, 32 consecutive trans-ulnar basal coronoid fracture-dislocations underwent open reduction and internal fixation at our institution. Four elbows were lost to follow-up within the first 6 months after surgery and were excluded. Among the 28 elbows remaining, there were 13 females and 15 males with a mean age of 56 (range 28-78) years at the time of injury. The mean clinical and radiographic follow-up times were 37 months and 29 months, respectively. Radiographs were reviewed to determine rates of union, Hastings and Graham heterotopic ossification (HO) grade, and Broberg and Morrey arthritis grade.
Union occurred in 25 elbows. Union could not be determined for 1 elbow at most recent follow-up and the remaining 2 elbows developed nonunion of the coronoid. Complications occurred in 10 elbows (36%): deep infection (4), ulnar neuropathy (2), elbow contracture (2), and nonunion (2). There were reoperations in 11 elbows (39%): irrigation and débridement with hardware removal (4), hardware removal (2), ulnar nerve transposition (2), contracture release with HO removal (2), and revision with iliac crest autograft (1). At most recent follow-up, the mean flexion-extension arc was 106° (range 10°-150°), and the mean pronation-supination arc was 137° (range 0°-170°). The mean Quick Disabilities of Arm, Shoulder, and Hand score was 11 (range 0-39) points with a mean Single Assessment Numeric Evaluation-Elbow score of 81 (range 55-100) points. At final radiographic follow-up, 16 elbows (57%) had HO (8 class I and 8 class II), and 20 elbows (71%) had arthritis (8 grade 1, 6 grade 2, and 6 grade 3).
Trans-ulnar basal coronoid fracture-dislocations are severe injuries associated with high rates of reoperation, HO, and post-traumatic arthritis. However, the majority of elbows achieve union, a functional range of motion, and reasonable patient reported outcome measures. Over the study period, surgeons were more likely to utilize multiple deep approaches and separate fixation of the coronoid (either with lag screws or anteromedial plates) to ensure anatomic reduction.
肘的经尺骨骨折脱位是复杂的损伤，难以进行分类和治疗。冠状突基底经尺骨骨折脱位，其中冠状突既不附着于尺骨鹰嘴也不附着于干骺端，实现解剖复位和稳定内固定具有很大的挑战性。本研究旨在分析经尺骨冠状突基底骨折脱位的手术治疗结果。
在 2002 年至 2019 年期间，32 例连续经尺骨冠状突基底骨折脱位患者在我院接受了切开复位内固定治疗。术后 6 个月内有 4 例肘部失访，予以排除。在其余 28 例肘部中，有 13 例女性和 15 例男性，受伤时的平均年龄为 56（28-78）岁。平均临床和放射学随访时间分别为 37 个月和 29 个月。影像学检查确定了愈合率、Hastings 和 Graham 异位骨化（HO）分级，以及 Broberg 和 Morrey 关节炎分级。
25 例肘部愈合。在最近的随访中，1 例肘部最多只能确定部分愈合，其余 2 例发生冠状突骨不连。10 例肘部发生并发症（36%）：深部感染（4 例）、尺神经病变（2 例）、肘挛缩（2 例）和骨不连（2 例）。11 例肘部进行了再手术（39%）：灌洗清创和去除内固定（4 例）、去除内固定（2 例）、尺神经转位（2 例）、HO 去除和挛缩松解（2 例）、髂嵴自体骨移植翻修（1 例）。在最近的随访中，平均屈伸弧为 106°（范围 10°-150°），平均旋前旋后弧为 137°（范围 0°-170°）。平均 Quick Disabilities of Arm, Shoulder, and Hand 评分（DASH）为 11（范围 0-39）分，平均单因素评估数值评估-肘（SANE）评分为 81（范围 55-100）分。在最终放射学随访时，16 例肘部（57%）有 HO（8 例 I 级和 8 例 II 级），20 例肘部（71%）有关节炎（8 例 1 级，6 例 2 级，6 例 3 级）。
经尺骨冠状突基底骨折脱位是严重的损伤，与高再手术率、HO 和创伤后关节炎有关。然而，大多数肘部实现了愈合、功能活动范围和合理的患者报告结果。在研究期间，外科医生更倾向于采用多个深部入路和冠状突的单独固定（使用拉力螺钉或前内侧钢板），以确保解剖复位。
