Jung Hyoung-Seok, Nam Hyun-Cheul, Chu Min Su, Lee Jae-Sung
Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea.
Clin Orthop Surg. 2025 Apr;17(2):300-307. doi: 10.4055/cios24169. Epub 2025 Jan 7.
The rarity and complexity of trans-ulnar basal coronoid fracture-dislocations pose significant challenges in treatment. This study aimed to categorize these fractures based on coronoid fracture patterns and propose tailored surgical approaches for each type. Additionally, we evaluated the functional and radiological outcomes among the patients managed using our treatment algorithm.
A total of 19 patients who underwent open reduction and internal fixation for trans-ulnar basal coronoid fracture-dislocations between March 2018 and October 2022 were enrolled in this study. These patients were classified based on the coronoid fracture patterns associated with olecranon fractures: type 1 involved anteromedial facet (AMF) fractures, type 2 encompassed coronoid base and body fractures, and type 3 involved a combination of types 1 and 2. We made a midline longitudinal dorsal incision to facilitate the provisional fixation of the olecranon fragment to the distal metaphysis using a locking plate. Subsequently, we employed the over-the-top (type 1) and Taylor-Scham (type 3) approaches for direct coronoid process fixation with buttress plating. Type 2 fractures were approached via medial fascial exposure from the posterior ulnar cortex or through the olecranon fractures, and subsequently fixed with miniplates and screws. Bony union and joint articulation were assessed via plain radiographs, and functional outcomes were evaluated using range of motion and the Mayo Elbow Performance Score.
Among the 19 patients, 3 had type 1 fractures, 14 had type 2 fractures, and 2 had type 3 fractures. All fractures exhibited solid osseous union without subluxation or dislocation. The average flexion and extension arc was 119.47° ± 20.88°, with a mean flexion of 127.37° ± 13.37° and an average flexion contracture of 7.89° ± 10.04°. The average Mayo Elbow Performance Score was 82.63 ± 12.51 points. Qualitatively, patient outcomes were excellent in 5 patients, good in 9, and fair in 5.
Most of our patients presented with easily approachable coronoid base and body fractures. However, in AMF fractures of the coronoid process, a direct medial approach is required for buttress plating. We believe our study helps provide useful guidelines for making appropriate decisions in trans-ulnar basal coronoid fracture-dislocations.
经尺骨冠状突基底骨折脱位的罕见性和复杂性给治疗带来了重大挑战。本研究旨在根据冠状突骨折类型对这些骨折进行分类，并针对每种类型提出定制的手术方法。此外，我们评估了使用我们的治疗方案治疗的患者的功能和影像学结果。
本研究纳入了2018年3月至2022年10月期间因经尺骨冠状突基底骨折脱位接受切开复位内固定的19例患者。这些患者根据与鹰嘴骨折相关的冠状突骨折类型进行分类：1型包括前内侧关节面（AMF）骨折，2型包括冠状突基底和体部骨折，3型包括1型和2型的组合。我们做了一个中线纵向背侧切口，以便使用锁定钢板将鹰嘴骨折块临时固定到干骺端远端。随后，我们采用经鹰嘴（1型）和泰勒-沙姆（3型）方法，用支撑钢板直接固定冠状突。2型骨折通过从尺骨后皮质内侧筋膜暴露或通过鹰嘴骨折进入，随后用微型钢板和螺钉固定。通过X线平片评估骨愈合和关节对位情况，使用活动范围和梅奥肘关节功能评分评估功能结果。
19例患者中，3例为1型骨折，14例为2型骨折，2例为3型骨折。所有骨折均实现了牢固的骨愈合，无半脱位或脱位。平均屈伸弧度为119.47°±20.88°，平均屈曲度为127.37°±13.37°，平均屈曲挛缩为7.89°±10.04°。平均梅奥肘关节功能评分为82.63±12.51分。定性评估，5例患者的结果为优，9例为良，5例为中。
我们的大多数患者表现为易于处理的冠状突基底和体部骨折。然而，在冠状突的AMF骨折中，需要采用直接内侧入路进行支撑钢板固定。我们相信我们的研究有助于为经尺骨冠状突基底骨折脱位的恰当决策提供有用的指导。
