Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy...Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.展开更多
Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal sta...Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal stability.The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.Methods Between March 2008 and June 2011,a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods.Of them,24 patients were treated by perpendicular plating （group Ⅰ） and 21 patients were treated by parallel plating （group Ⅱ）.The surgical time,blood loss,and union time were compared between the two groups.The fiexion-extension arc,the total range of flexion and extension at the end of follow-up were compared between the two groups.The Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up.The mean duration of follow-up was 16 months （range 12-25 months） in group Ⅰ and 15.5 months in group Ⅱ （range 12-25 months）.There were no significant differences in the surgical time,blood loss,and the bone union time between the two groups.In group Ⅰ,the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points.The rate of excellent and good results was 87.5%.In group Ⅱ,the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points.The rate of excellent and good results was 90.5%.There were no significant differences in the MEPS,flexion-extension arc,and the total range of flexion and extension between the two groups.Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation.The occurrence of post-operative elbow stiffness can b展开更多
Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related ...Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.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
Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is lar...Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is largely regained by TEA, comminuted condyle fragments are often ignored. Although numerous approaches for repair of condylar fragments around TEA are described, any universal fixation strategy for these fractures has not been established. This report describes, for the first time, application of an ultra-high molecular weight polyethylene (UHMWPE) tape for the treatment of distal humerus fracture in 2 patients with rheumatic elbow arthropathy. The post-operative clinical courses were good. Radiographs showed bony union of the condylar fragments without loosening in two cases. Because of its flat configuration, softness, and flexibility, UHMWPE tape is a promising material for stabilizing fracture of the distal humerus associated with TEA.展开更多
文摘Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.
文摘Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal stability.The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.Methods Between March 2008 and June 2011,a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods.Of them,24 patients were treated by perpendicular plating （group Ⅰ） and 21 patients were treated by parallel plating （group Ⅱ）.The surgical time,blood loss,and union time were compared between the two groups.The fiexion-extension arc,the total range of flexion and extension at the end of follow-up were compared between the two groups.The Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up.The mean duration of follow-up was 16 months （range 12-25 months） in group Ⅰ and 15.5 months in group Ⅱ （range 12-25 months）.There were no significant differences in the surgical time,blood loss,and the bone union time between the two groups.In group Ⅰ,the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points.The rate of excellent and good results was 87.5%.In group Ⅱ,the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points.The rate of excellent and good results was 90.5%.There were no significant differences in the MEPS,flexion-extension arc,and the total range of flexion and extension between the two groups.Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation.The occurrence of post-operative elbow stiffness can b
文摘Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.
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Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is largely regained by TEA, comminuted condyle fragments are often ignored. Although numerous approaches for repair of condylar fragments around TEA are described, any universal fixation strategy for these fractures has not been established. This report describes, for the first time, application of an ultra-high molecular weight polyethylene (UHMWPE) tape for the treatment of distal humerus fracture in 2 patients with rheumatic elbow arthropathy. The post-operative clinical courses were good. Radiographs showed bony union of the condylar fragments without loosening in two cases. Because of its flat configuration, softness, and flexibility, UHMWPE tape is a promising material for stabilizing fracture of the distal humerus associated with TEA.
