Heim U
AO-Internationale, Davos, Suisse.
Rev Chir Orthop Reparatrice Appar Mot. 1998 Apr;84(2):142-53.
The purpose of this study was to increase the knowledge about these rare and serious injuries and to produce guidelines for a more successful ORIF.
120 cases of combined fractures in adults with late results (minimum one year) stored in the AO Documentation-Center between 1979 and 1989 were analyzed. Monotrauma was dominant, additional injuries were rare. No vasculo-nervous lesions were reported. 15 fractures were open. For the ulna 4 fractures types were isolated, fractures of the coronoid process and the radial head (CR) 25 cases. Olecranon and radial head fracture (OR) 22 cases. Combination of anterior (coronoid) and posterior (olecranon) ulnar fracture with radial head fracture (COR) 41 cases. Metaphyseal ulnar and radial head fractures (MR) 32 cases. For the radial head we have distinguished partial (61) and complete (59) fractures, the latter including 14 neck fractures.
In the CR type indirect fixation technique was never perfect. Best results were obtained after ORIF of partial radial fractures. After resection, arthrosis (8/11) and valgus (8/11) were very frequent. In the OR type the stability was restored in simple fractures by the tension band technique even when the radial head was resected. In the severe COR type good results were rare. Arthrosis was important and frequent (36/41) especially after radial head resection. In the MR type ORIF of the radial head combined with ulnar plating gave the best results. Ulnar union was delayed or missing in 13 cases especially after radial head resection. Functional results after one year were better than expected on X-rays. This was due to immediate ORIF (92/120) and early mobilization. There were only 3 infections and 2 reflex-dystrophies.
The Coronoid is the key-fragment of the ulna. It is best reduced in CR-Type under vision by an anterior approach. In COR-lesions its reduction should be the first step of ulnar ORIF. Comminutions in OR, COR and MR-Types showed a high number of delayed or non union. The reason may be a biological weakness (reduced vascularization) in these areas. Therefore we advocate for bridging plates (and cancellous grafts) for the stabilization of such areas, especially for the metaphysis where a strong valgus force appears after radial resection. Radial head as the lateral pillar of the elbow should be restored by ORIF in partial fractures (excellent results) and even in complete fractures (5/10 excellent results) under favourable conditions. Prosthesis is indicated in severe radial comminution or serious ulnar instability.
本研究旨在增加对这些罕见且严重损伤的认识，并制定更成功的切开复位内固定（ORIF）指南。
分析了1979年至1989年存储在AO文献中心的120例成人合并骨折的晚期结果（至少一年）。单一创伤占主导，附加损伤罕见。未报告血管神经损伤。15处骨折为开放性骨折。尺骨分离出4种骨折类型，冠状突和桡骨头骨折（CR）25例。鹰嘴和桡骨头骨折（OR）22例。尺骨前（冠状突）后（鹰嘴）骨折合并桡骨头骨折（COR）41例。尺骨干骺端和桡骨头骨折（MR）32例。对于桡骨头，我们区分了部分骨折（61例）和完全骨折（59例），后者包括14例颈部骨折。
在CR型中，间接固定技术从未达到完美。部分桡骨骨折切开复位内固定后获得最佳结果。切除后，关节病（8/11）和外翻（8/11）非常常见。在OR型中，即使切除桡骨头，简单骨折通过张力带技术恢复了稳定性。在严重的COR型中，良好结果罕见。关节病很重要且常见（36/41），尤其是在桡骨头切除后。在MR型中，桡骨头切开复位内固定结合尺骨钢板固定效果最佳。13例尺骨愈合延迟或未愈合，尤其是在桡骨头切除后。一年后的功能结果在X线片上比预期更好。这归因于立即切开复位内固定（92/120）和早期活动。仅3例感染和2例反射性交感神经营养不良。
冠状突是尺骨的关键骨折块。在CR型中，通过前路在直视下最好进行复位。在COR损伤中，其复位应是尺骨切开复位内固定的第一步。OR、COR和MR型中的粉碎性骨折显示大量延迟愈合或不愈合。原因可能是这些区域的生物学弱点（血管化减少）。因此，我们主张使用桥接钢板（和松质骨移植）来稳定这些区域，特别是对于桡骨切除后出现强大外翻力的干骺端。桡骨头作为肘部的外侧支柱，在部分骨折（效果极佳）甚至完全骨折（5/10效果极佳）且条件有利时，应通过切开复位内固定进行恢复。在严重桡骨粉碎或严重尺骨不稳定时，应使用假体。
