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Zhang X, Wang Y, Wang Q, Zhu Y, Zhang J. Comparison of buttress plate and cannulated screw in the treatment of anteromedial coronoid fracture with elbow posteromedial rotatory instability. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05855-1. [PMID: 37270455 DOI: 10.1007/s00264-023-05855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study is to compare the effect of buttress plate and cannulated screw in the treatment of anteromedial coronoid fracture with posteromedial rotatory instability (PMRI). METHODS We retrospectively evaluated patients who were diagnosed with O'Driscoll type 2 fractures combined with elbow posteromedial rotatory instability and underwent surgery for anteromedial coronoid fracture between August 2014 and March 2019. They were divided into buttress plate (n=16) and cannulated screw (n=11) groups. The elbow range of motion, visual analog scale (VAS), Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder, and hand score (DASH) were used for clinical outcome assessment. RESULT There were no significant differences in clinical outcomes. However, the surgical time was significantly shorter in cannulated screw group (85.45±4.156) compared to the buttress plate group (93.81±8.863, P=0.008), and the surgical time was associated with internal fixation (P=0.008). CONCLUSION Although there was selection of cases in that small fragments were treated with buttress plate and large fragments with cannulated screw, the buttress plate and cannulated screw have comparable functional outcomes on fixation of the anteromedial coronoid fracture with elbow PMRI. The fixation of the anteromedial coronoid fracture with large fragments using the cannulated screw has a shorter operation time.
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Affiliation(s)
- Xinan Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
| | | | - Qing Wang
- Tianjin Hospital, Tianjin, 300211, China
| | | | - Juntao Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300380, China
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Lee HD, Jung YJ, Oh JK, Moon JG. Morphological characteristics of fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow: a three-dimensional CT remodeling study. J Shoulder Elbow Surg 2021; 30:1527-1536. [PMID: 33157240 DOI: 10.1016/j.jse.2020.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow are classified into 3 subtypes based on their location. The purpose of this study was to analyze the fracture morphology of anteromedial facet fractures in their 3 subtypes (anteromedial rim, anteromedial rim + tip, and anteromedial rim + sublime tubercle [±tip]). METHODS Three-dimensional computed tomography remodeling was used to evaluate anteromedial facet fractures in a consecutive series of 40 patients, all of whom were affected by posteromedial rotatory instability of the elbow. Characteristics of the fractures, including the number of fragments, size of fragments, plane of the fracture line, and involvement of the sublime tubercle and radial notch, were measured for each subtype of the anteromedial facet fractures. RESULTS Each subtype had a typical fracture pattern and distinct size. The fracture subtype 1 showed a single-fragment fracture, subtype 2 showed either a single- or dual-fragment fracture, and subtype 3 showed either a dual- or triple-fragment fracture. The angle between the fracture line and the coronal plane was greatest in subtype 3 fractures. The surface area of the fragment was largest in subtype 3 fractures. The percentages of articular involvement of the sublime tubercle were 0% in subtype 1, 47% in subtype 2, and 79% in subtype 3. The percentages of articular involvement of the radial notch were 0% in subtype 1, 7% in subtype 2, and 8% in subtype 3. CONCLUSION Analysis with quantitative 3-dimensional computed tomography showed the characteristic morphology of each subtype of anteromedial facet fracture. Subtype 1 comprised 1 fragment with the smallest fragment size. Subtype 2 was a single- or dual-fragment fracture, the size of which should be considered in the treatment plan. Subtype 3 was a large fragment comprising the sublime tubercle. Our findings are significant because they highlight unique fracture morphology that may help surgeons to distinguish one fracture subtype from another in clinical practice.
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Affiliation(s)
- Hee-Dong Lee
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
| | - Young-Jin Jung
- Department of Orthopaedic Surgery, Cheongra Barun Orthopaedic Center, Incheon, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
| | - Jun-Gyu Moon
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea.
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Klug A, Buschbeck S, Gramlich Y, Buckup J, Hoffmann R, Schmidt-Horlohé K. Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid—a retrospective study of twenty-four patients. INTERNATIONAL ORTHOPAEDICS 2019; 43:2817-2824. [DOI: 10.1007/s00264-019-04354-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/30/2019] [Indexed: 12/18/2022]
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Arrigoni P, Cucchi D, Guerra E, Luceri F, Nicoletti S, Menon A, Randelli P. No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures. Knee Surg Sports Traumatol Arthrosc 2019; 27:314-318. [PMID: 29610971 DOI: 10.1007/s00167-018-4926-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/28/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Arthroscopic reduction and internal fixation for coronoid process fractures has been proposed to overcome limitations of open approaches. Currently, arthroscopy is most frequently used to assist insertion of a retrograde guide wire for a retrograde cannulated screw. The present anatomical study presents an innovative arthroscopic technique to introduce an antegrade guide wire from an accessory anteromedial portal and evaluates its safety and reproducibility. METHODS Six fresh-frozen cadaver specimens were obtained and prepared to mimic an arthroscopic setting. The coronoid process was localized and a 0.9 mm Kirschner wire was introduced from an accessory anteromedial portal, located 2 cm proximal to the standard anteromedial portal. At the end of the procedure, a lateral radiograph was taken to verify the Kirschner wire position and open dissection was conducted to evaluate possible damage to neurovascular structures. RESULTS The Kirschner wire was drilled without complications in the coronoid process of all six specimens. Damage of the brachial artery, the median nerve, and the ulnar nerve did not occur in any specimen. A corridor between the brachialis muscle, the median intermuscular septum, and the pronator teres could be identified as suitable for the wire passage. CONCLUSION This study presents a safe and reproducible technique combining the possibility to introduce a guide wire from the anteromedial part of the coronoid, under direct visual control, with a completely arthroscopic approach. This wire can guide the introduction of a retrograde cannulated screw from the dorsolateral ulna to the tip of the coronoid. This new arthroscopic approach permits to obtain improved visual control over coronoid process fixation, without endangering neurovascular structures.
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Affiliation(s)
- Paolo Arrigoni
- 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. .,Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Enrico Guerra
- Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Luceri
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Nicoletti
- Azienda USL Toscana Centro-Sede: Ospedale San Jacopo, Via Ciliegiole, 120, 51100, Pistoia, Italy
| | - Alessandra Menon
- 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Pietro Randelli
- 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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Ouyang K, Wang D, Lu W, Xiong J, Xu J, Peng L, Liu H, Li H, Feng W. Arthroscopic reduction and fixation of coronoid fractures with an exchange rod-a new technique. J Orthop Surg Res 2017; 12:9. [PMID: 28100234 PMCID: PMC5241964 DOI: 10.1186/s13018-016-0505-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ulnar coronoid process plays a central role in maintaining elbow stability. Some of its fractures were often combined with injury of bone and ligament. Arthroscopy enables perfect visualization to allow anatomical repair. METHODS From January 2012 to December 2013, six patients (four males, two females) with a mean age of 26.6 years were treated. The left and right ulnas were involved in two and four patients, respectively. All patients suffered from ipsilateral subluxation of the elbow without associated radial fracture. According to the Regan and Morrey fracture classification and O'Driscoll's classification, two and four patients were classified as type I and type II and as having tip fracture (O'Driscoll type I) and anteromedial fracture (O'Driscoll type II), respectively. Exchange rod technology via the elbow front center approach was used for reduction and fixation of fractures of the coronoid process of the ulna. RESULTS Intra- and postoperative X-ray examination showed that the fractures were satisfactorily fixed and that the screw and fracture line were vertical to each other. Follow-ups showed that the fractures had healed well, and the average elbow extension was -2° while the average flexion was 140°. No problems related to pronation or supination, elbow instability, or complications of blood vessels or nerves were reported. The elbows showed excellent results according to the Mayo Elbow Performance Score. CONCLUSIONS Arthroscopy using an exchange rod can provide excellent visual exposure of the fractured joints, without the need for a large incision during the anatomical repair. Moreover, it protects the surrounding soft tissue, shows good stability of the components, and allows early rehabilitation exercises.
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Affiliation(s)
- Kan Ouyang
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Daping Wang
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China.
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Jianyi Xiong
- Department of Orthopaedics, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Jian Xu
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Liangquan Peng
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Haifeng Liu
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Hao Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
| | - Wenzhe Feng
- Department of Sports Medicine, Shenzhen Second People's Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China
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