Bagga Rahul, Stone Andrew, Dirckx Margo, Murphy Richard J, Phadnis Joideep
Department of Orthopaedic Surgery, Royal County Sussex Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Department of Orthopaedic Surgery, Royal County Sussex Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK.
J Shoulder Elbow Surg. 2025 Aug;34(8):2005-2014. doi: 10.1016/j.jse.2024.11.026. Epub 2025 Jan 20.
Proximal ulna fracture dislocations comprise a wide spectrum of injury. The Coronoid, proximal Ulna, Radius and Ligaments (CURL) classification is a simple framework designed to aid surgical decision-making by focusing attention on the key components of the injury and their relative severity. It has been demonstrated to have a high interobserver and intraobserver reliability. The aim of this study was to analyze the prognostic value of the CURL classification with respect to patient outcome.
The CURL framework was applied retrospectively to 182 patients treated surgically for a proximal ulna fracture dislocation in a level 1 trauma center. Patient outcomes collected included complication rate, reoperations, patient satisfaction, and Oxford Elbow Score (OES). The CURL score overall and each individual component were assessed for the effect on outcome. Appropriateness of surgical fixation was also assessed and correlated with outcome.
Of 182 patients, 69 (37.9%) had at least 1 major or minor complication and the overall CURL score was associated with a higher rate of complications (r = 0.85, P = .02). The presence of a coronoid fracture as well as the radial head and ligament components was associated with increased complications (coronoid: r = 0.26, P < .01; radial head: r = 0.36, P < .01; ligament: r = 0.38, P < .01). The complication rate was higher as the CURL value increased for both coronoid and radial head components (coronoid score 0 = 30.9%, coronoid score 1 = 54.6%, coronoid score 2 = 69.2% and radial head score 0 = 26.1%, radial head score 1 = 50.0%, radial head score 2 = 73.3%). The median OES was 43, and the total CURL score was correlated with inferior OES (r = -0.89, P = .01) as were the coronoid, radial head, and ligament components (coronoid: r = -0.43, P < .01; radial head: r = -0.38, P < .01; ligament: r = -0.42, P < .01). The proximal ulna fracture severity was not correlated with increased complication rate or OES. Patients deemed to have inappropriate fixation (20.8%) had a significantly higher complication rate (65.8% vs. 30.5%, P ≤ .001), with the 9 patients with inadequate coronoid fixation demonstrating a 100.0% complication rate.
Proximal ulna fracture dislocations have a high complication rate and are intolerant to inadequate fixation. The CURL system demonstrates prognostic value with the coronoid component most influential on outcome.
尺骨近端骨折脱位包含多种损伤情况。冠状突、尺骨近端、桡骨及韧带（CURL）分类是一个简单的框架，旨在通过关注损伤的关键组成部分及其相对严重程度来辅助手术决策。已证明其具有较高的观察者间和观察者内可靠性。本研究的目的是分析CURL分类对患者预后的预测价值。
将CURL框架回顾性应用于182例在一级创伤中心接受手术治疗的尺骨近端骨折脱位患者。收集的患者预后指标包括并发症发生率、再次手术情况、患者满意度和牛津肘关节评分（OES）。评估CURL总分及各个组成部分对预后的影响。还评估了手术固定的适宜性并将其与预后相关联。
182例患者中，69例（37.9%）至少发生1种主要或次要并发症，CURL总分与较高的并发症发生率相关（r = 0.85，P = 0.02）。冠状突骨折以及桡骨头和韧带组成部分的存在与并发症增加相关（冠状突：r = 0.26，P < 0.01；桡骨头：r = 0.36，P < 0.01；韧带：r = 0.38，P < 0.01）。随着冠状突和桡骨头组成部分的CURL值增加，并发症发生率更高（冠状突评分0 = 30.9%，冠状突评分1 = 54.6%，冠状突评分2 = 69.2%；桡骨头评分0 = 26.1%，桡骨头评分1 = 50.0%，桡骨头评分2 = 73.3%）。OES中位数为43，CURL总分与较低的OES相关（r = -0.89，P = 0.01），冠状突、桡骨头和韧带组成部分也如此（冠状突：r = -0.43，P < 0.01；桡骨头：r = -0.38，P < 0.01；韧带：r = -0.42，P < 0.01）。尺骨近端骨折的严重程度与并发症发生率增加或OES无关。被认为固定不恰当的患者（20.8%）并发症发生率显著更高（65.8%对30.5%，P ≤ 0.001），9例冠状突固定不充分的患者并发症发生率为100.0%。
尺骨近端骨折脱位并发症发生率高，对固定不充分难以耐受。CURL系统显示出预测价值，其中冠状突组成部分对预后影响最大。
