The Challenge of Trans-Ulnar Basal Coronoid Fracture-Dislocations: A Surgical Strategy Based on the Pattern of Coronoid Fracture.

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-04-01 Epub Date: 2025-01-07 DOI:10.4055/cios24169
Hyoung-Seok Jung, Hyun-Cheul Nam, Min Su Chu, Jae-Sung Lee
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Abstract

Backgroud: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

经尺基底冠状骨骨折脱位的挑战:基于冠状骨骨折模式的手术策略。
背景:经尺骨基底冠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面骨折类型对这些骨折进行分类,并针对每种类型提出量身定制的手术入路。此外,我们评估了使用我们的治疗算法管理的患者的功能和放射学结果。方法:2018年3月至2022年10月期间,共19例经尺侧基底冠状面骨折脱位患者接受切开复位内固定。这些患者根据与鹰嘴骨折相关的冠状面骨折类型进行分类:1型涉及前内侧突(AMF)骨折,2型涉及冠状面基部和体骨折,3型涉及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碎片临时固定在远端干骺端。随后,我们采用了over- top(1型)和Taylor-Scham(3型)入路进行冠突直接固定,并采用支撑钢板。2型骨折经尺后皮质内侧筋膜暴露或鹰嘴骨折入路,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关节,并使用活动范围和Mayo肘关节功能评分评估功能结果。结果:19例患者中,1型骨折3例,2型骨折14例,3型骨折2例。所有骨折均表现为牢固的骨愈合,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°,平均屈曲挛缩度为7.89°±10.04°。Mayo肘关节功能评分平均为82.63±12.51分。从质量上看,5例患者的预后为优秀,9例为良好,5例为一般。结论:本组患者多为易接近的冠底骨折和体骨折。然而,在冠突AMF骨折中,需要直接内侧入路进行支撑钢板。我们相信我们的研究有助于为经尺骨基底冠状面骨折脱位的适当治疗提供有用的指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
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