Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the ra...Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface fol owing distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach(direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.展开更多
Purpose:Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the...Purpose:Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.Methods:Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.Results:The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.Conclusion:The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.展开更多
目的探讨肘后路结合多种固定在肱骨远端冠状面骨折中的临床应用。方法自2005年1月至2018年1月,本科共收治18例肱骨远端冠状面骨折患者,其中女15例、男3例,平均年龄50岁。摔倒10例,机动车交通事故4例,运动损伤1例,高处掉落3例。手术均顺...目的探讨肘后路结合多种固定在肱骨远端冠状面骨折中的临床应用。方法自2005年1月至2018年1月,本科共收治18例肱骨远端冠状面骨折患者,其中女15例、男3例,平均年龄50岁。摔倒10例,机动车交通事故4例,运动损伤1例,高处掉落3例。手术均顺利完成,采用肘后侧入路切开复位内固定,术中使用多种内固定方式固定骨折端。术后药物抗炎、止痛、预防固化性肌炎,携带肘关节支具保护6周,循序康复锻炼。结果手术时间60~100 min,平均75 min。术后切口均I期愈合,均获骨性愈合,愈合平均时间6个月。本组患者上肢功能评分表(disability of arm shoulder and hand,DASH)评分20分。无骨不连和神经损伤病例,有2例创伤性关节炎(1例Broberg-Morrey1级,另1例Broberg-Morrey 2级,均行保守治疗),1例异位骨化(Brooker 1级,无症状)。结论肘后路结合多种固定治疗肱骨远端冠状面骨折的方法,具有骨折显露充分、固定牢固、安全有效、易处理合并损伤等优点,临床疗效好。展开更多
Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)a...Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)approach and olecranon osteotomy(00).At the same time,we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus,and whether it is convenient to convert to the treatment to total elbow arthroplasty(TEA)or 00.Methods:Patients treated with 00 and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed.Inclusion criteria include:(1)patients'age were more than 18 years old,(2)follow-up was no less than 6 months,and(3)patients were diagnosed with type C fractures(based on the AO/OTA classification).Exclusion criteria include:(1)open fractures(Gustillo type 2 or type 3),(2)treated by other approaches,and(3)presented with combined injuries of ipsilateral upper extremities,such as ulnar nerve.Elbow range of motion and triceps extension strength testing were completely valuated,when the fractures had healed.Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up.The data were compared using the two tailed Student's t-test.All data were presented as mean±standard deviation.Results:Eighty-six patients of type C distal humerus fractures,treated by 00 and BTT approach were retrospectively reviewed between July 2014 and December 2017.Fifty-five distal humerus fractures(23 males and 32 females,mean age 52.7 years)treated by BTT approach or 00 were included in this study.There were 10 fractures of type Cl,16 type C2 and 29 type C3 according to the AO/OTA classification.Patients were divided into two surgical approach groups chosen by the operators:BTT group(28 patients)and 00 group(27 patients).And the mean follow-up time of all patients was 15.6 months(range,6-36 months).Three cases in BTT group were convert展开更多
文摘Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface fol owing distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach(direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.
文摘Purpose:Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.Methods:Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.Results:The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.Conclusion:The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.
文摘目的探讨肘后路结合多种固定在肱骨远端冠状面骨折中的临床应用。方法自2005年1月至2018年1月,本科共收治18例肱骨远端冠状面骨折患者,其中女15例、男3例,平均年龄50岁。摔倒10例,机动车交通事故4例,运动损伤1例,高处掉落3例。手术均顺利完成,采用肘后侧入路切开复位内固定,术中使用多种内固定方式固定骨折端。术后药物抗炎、止痛、预防固化性肌炎,携带肘关节支具保护6周,循序康复锻炼。结果手术时间60~100 min,平均75 min。术后切口均I期愈合,均获骨性愈合,愈合平均时间6个月。本组患者上肢功能评分表(disability of arm shoulder and hand,DASH)评分20分。无骨不连和神经损伤病例,有2例创伤性关节炎(1例Broberg-Morrey1级,另1例Broberg-Morrey 2级,均行保守治疗),1例异位骨化(Brooker 1级,无症状)。结论肘后路结合多种固定治疗肱骨远端冠状面骨折的方法,具有骨折显露充分、固定牢固、安全有效、易处理合并损伤等优点,临床疗效好。
文摘Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)approach and olecranon osteotomy(00).At the same time,we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus,and whether it is convenient to convert to the treatment to total elbow arthroplasty(TEA)or 00.Methods:Patients treated with 00 and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed.Inclusion criteria include:(1)patients'age were more than 18 years old,(2)follow-up was no less than 6 months,and(3)patients were diagnosed with type C fractures(based on the AO/OTA classification).Exclusion criteria include:(1)open fractures(Gustillo type 2 or type 3),(2)treated by other approaches,and(3)presented with combined injuries of ipsilateral upper extremities,such as ulnar nerve.Elbow range of motion and triceps extension strength testing were completely valuated,when the fractures had healed.Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up.The data were compared using the two tailed Student's t-test.All data were presented as mean±standard deviation.Results:Eighty-six patients of type C distal humerus fractures,treated by 00 and BTT approach were retrospectively reviewed between July 2014 and December 2017.Fifty-five distal humerus fractures(23 males and 32 females,mean age 52.7 years)treated by BTT approach or 00 were included in this study.There were 10 fractures of type Cl,16 type C2 and 29 type C3 according to the AO/OTA classification.Patients were divided into two surgical approach groups chosen by the operators:BTT group(28 patients)and 00 group(27 patients).And the mean follow-up time of all patients was 15.6 months(range,6-36 months).Three cases in BTT group were convert
