Objective To evaluate the effectiveness of the AO anatomical locking compression plate in treating type C distal humeral fracture. Methods Between July 2008 and April 2009, 13 cases of type C distal humeral fracture were treated with the AO anatomical locking compression plates. There were 5 males and 8 females with an average age of 52.1 years (range, 24-80 years). Fractures were caused by tumbl ing in 7 cases, by traffic accident in 4 cases, and by fall ing from height in2 cases. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 3 cases of type C1, 6 cases of type C2, and 4 cases of type C3. Two cases compl icated by ulnar nerve injuries, 1 by radial nerve injury, 2 by fractures of ulnar olecranon, 3 by fractures of other parts of extremities, and 6 by osteoporosis. The time from injury to hospital ization ranged from 3 hours to 4 days (0.9 day on average). Results All the incisions achieved heal ing by first intention. Thirteen cases were followed up 12 to 21 months with an average of 15.9 months. According to the X-ray films, unions were achieved both at fracture site and the olecranon osteotomy site with a heal ing time of 8 to 13 weeks (10 weeks on average). The function of elbows recovered from 3 to 32 weeks (10 weeks on average). No fixation failure, myositis ossifican, delayed union, or malunion occurred during the follow-up. The Mayo Elbow Performance score ranged from 75 to 100 with an average score of 95.8; the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion The AO anatomical locking compression plate has a good fixation in treating type C distal humeral fracture. Through the approach of olecranon osteotomy, it is easy to get anatomical reduction, stable fixation, and early exercise.
ObjectiveTo investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. MethodsBetween February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. ResultsAll incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. ConclusionAnterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.
Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
Objective To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. Methods Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum-trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. Results All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). Conclusion For Dubberley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional results.
ObjectiveTo compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3 (AO/OTA) distal humeral fractures and investigate the details of operation.MethodsBetween April 2010 and September 2016, 36 type C3 (AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group (group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group (group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age, dominant side, interval between injury and surgery, causes of injury between 2 groups (P>0.05). Patients were followed up, the postoperative range of motion of elbow joint, strength, pain, and stability in 2 groups were documented and compared; the elbow joint function was evaluated according to Mayo elbow performance score (MEPS).ResultsThe operation time of group A [(115.0±10.4) minutes] was less than that of group B [(121.0±12.3) minutes], but there was no significant difference (t=–1.580, P=0.123). All patients in 2 groups got over 1 year follow-up and there was no significant difference of the follow-up time between 2 groups (t=–0.843, P=0.405). There was 1 case of heterotopic ossification in each group; 1 case of incision infection in group A and 1 case of incision superficial infection in group B, and were cured after 2 weeks of intravenous antibiotics administration. There was no other operative complications in the 2 groups. At 3 months after operation, all the distal humerus healed. At last follow-up, the elbow flexion extension range of groups A and B were (102.0±12.6)° and (99.5±10.1)° respectively, showing no significant difference (t=–0.681, P=0.501). The MEPS scores of groups A and B were 82.9±7.3 and 81.3±7.2 respectively, showing no significant difference (t=0.670, P=0.507); and the evaluation grade also showed no significant difference between 2 groups (Z=–0.442, P=0.659).ConclusionBy paratricipital approach and proper traction of the olecranon, the distal humeral articular surface can be exposed in the operation of type C3 distal humeral fractures, followed with same stable fixation after reduction, the effectiveness is equal to by chevron olecranon V osteotomy approach.
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.
Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction.Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(n=12)； ②release of the medial collateral ligament(n=6)；③ excision of the radial head(n=6)；④excision of the radial head together with release of the medial collateral ligament(n=12)；⑤radial head replacement(n=6)；⑥medial collateral ligament reconstruction(n=6)；⑦radial head replacement together with medial collateral ligament reconstruction(n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software.Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (Plt;0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (Pgt;0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less.Conclusion The results of this studyshow that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity.Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can notbe carried out, the reconstruction of the medial collateral ligament is acceptable.
ObjectiveTo investigate the feasibility of modified classification of terrible triad of the elbow and the effectiveness of treatment strategy which was chosen by modified classification results. MethodsBetween March 2007 and November 2013, 12 cases of terrible triad of the elbow were treated by operation. There were 5 males and 7 females with an average age of 37.2 years (range, 26-74 years). The mechanism of injury was falling from height in 8 cases and traffic accident in 4 cases. The time from injury to operation was 4 to 11 days (mean, 6.8 days). According to the radial head, coronoid process, olecranon, and medial and lateral collateral ligament complexes injury situation, and based on Mason classification standard and O'Driscoll criteria, the classification standard of terrible triad of the elbow was improved. According to classification results, the approach was determined. The fracture reduction and fixation were performed and soft tissue was repaired. ResultsDehiscence of incision occurred in 1 case and was cured after dressing change; primary healing was obtained in the other patients. All the cases were followed up 19-35 months (mean, 21.6 months). The X-ray films showed fracture healing at 10-17 weeks (mean 12.8 weeks). At last follow-up, the mean flexion-extension arc of the elbow was 117.9° (range, 95-135°) and the mean forearm pronation and supination were 77.1° (range, 70-85°) and 62.5° (range, 45-75°). According to Mayo elbow performance score (MEPS), the results were excellent in 4 cases, good in 5 cases, and fair in 3 cases. One patient had valgus deformity of elbow who refused radial head replacement, and 5 cases had heterotopic ossification of the elbow on the X-ray films. ConclusionThe modified classification of the terrible triad of the elbow is simple and practical, based on the damage assessment of bony structures (radial head, coronoid process, and olecranon) and the soft tissue (medial and lateral collateral ligament complexes). The modified classification can be used effectively for guiding treatment decisions.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To analyze the effectiveness of binocular loupe assisted mini-lateral and medial incisions in lateral position for the release of elbow stiffness. Methods The clinical data of 16 patients with elbow stiffness treated with binocular loupe assisted mini-internal and external incisions in lateral position release between January 2021 and December 2022 were retrospectively analyzed. There were 9 males and 7 females, aged from 19 to 57 years, with a median age of 33.5 years. Etiologies included olecranon fracture in 6 cases, elbow dislocation in 4 cases, medial epicondyle fracture in 2 cases, radial head fracture in 4 cases, terrible triad of elbow joint in 2 cases, supracondylar fracture of humerus in 1 case, coronoid process fracture of ulna in 1 case, and humerus fracture in 1 case, with 5 cases presenting a combination of two etiologies. The duration of symptoms ranged from 5 to 60 months, with a median of 8 months. Preoperatively, 12 cases had concomitant ulnar nerve numbness, and 6 cases exhibited ectopic ossification. The preoperative range of motion for elbow flexion and extension was (58.63±22.30)°, the visual analogue scale (VAS) score was 4.3±1.6, and the Mayo score was 71.9±7.5. Incision lengths for both lateral and medial approaches were recorded, as well as the occurrence of complications. Clinical outcomes were evaluated using Mayo scores, VAS scores, and elbow range of motion both preoperatively and postoperatively. Results The lateral incision lengths for all patients ranged from 3.0 to 4.8 cm, with an average of 4.1 cm. The medial incision lengths ranged from 2.4 to 4.2 cm, with an average of 3.0 cm. The follow-up duration ranged from 6 to 19 months and a mean of 9.2 months. At last follow-up, 1 patient reported moderate elbow joint pain, and 3 cases exhibited residual mild ulnar nerve numbness. The other patients had no complications such as new heterotopic ossification and ulnar nerve paralysis, which hindered the movement of elbow joint. At last follow-up, the elbow range of motion was (130.44±9.75)°, the VAS score was 1.1±1.0, and the Mayo score was 99.1±3.8, which significantly improved when compared to the preoperative ones (t=−12.418, P<0.001; t=6.419, P<0.001; t=−13.330, P<0.001). ConclusionThe binocular loupe assisted mini-lateral and medial incisions in lateral position integrated the advantages of traditional open and arthroscopic technique, which demonstrated satisfying safety and effectivity for the release of elbow contracture, but it is not indicated for patients with posterior medial heterolateral heterotopic ossification.