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Zhou SC, Jin SY, Wang QY, Ren GK, Peng CG, Wang YB, Wu DK. Highly extensile approach for comminuted ulna coronoid process fractures with mini-plate fixation: a case series of 31 patients. BMC Musculoskelet Disord 2024; 25:522. [PMID: 38970051 PMCID: PMC11225124 DOI: 10.1186/s12891-024-07637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. METHODS Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. RESULTS The mean follow-up time was 26.7 months (range, 14-60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. CONCLUSION An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.
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Affiliation(s)
- Shi-Cheng Zhou
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China
| | - Sheng-Yu Jin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China
| | - Qing-Yu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China
| | - Guang-Kai Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China
| | - Chuan-Gang Peng
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China
| | - Yan-Bing Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China.
| | - Dan-Kai Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Jilin, Changchun, People's Republic of China.
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Yang F, Wang Z, Yuan T, Qin J. Treatment of Ulnar Coronoid Process Fracture Using the Anterior Neurovascular Interval Approach: A Retrospective Clinical Study with Short- to Mid-term Follow-up. Orthop Surg 2024; 16:1732-1743. [PMID: 38828840 PMCID: PMC11216846 DOI: 10.1111/os.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Numerous surgical techniques for addressing ulnar coronoid process fractures are available; however, a consensus on the optimal approach remains elusive. This study aimed to use the anterior neurovascular interval approach for the surgical management of ulnar coronoid process fractures and to evaluate its clinical outcomes over short- to mid-term follow-up. METHODS This retrospective clinical study included 20 patients with ulnar coronoid process fractures who were treated using the anterior neurovascular interval approach between January 2018 and December 2022. Participants comprised 16 males and four females, aged between 20 and 64 years (mean, 34.3 ± 12.44 years). Clinical and radiological evaluations were based on elbow joint range of motion (ROM), Visual analogue scale (VAS), and Mayo elbow performance score (MEPS). A paired t-test was used to compare the pre-operative and final follow-up VAS and MEPS scores. RESULTS The follow-up duration for all patients was at least 12 months (average, 12.65 ± 1.60 months). At the final follow-up, measurements of elbow ROM included a mean extension of 2.85 ± 3.17°, mean flexion of 135 ± 7.25°, mean pronation of 86.4 ± 4.56°, and mean supination of 84.85 ± 5.54°. All participants reached their target MEPS, with an average score of 97.25 ± 4.72 points, and the final mean VAS score was 0.2 ± 0.52 points. The VAS score was significantly lower and MEPS score was higher at the final follow-up than those before surgery (p < 0.05). Throughout the follow-up period, all the fractures united, and the stability of the affected elbows was satisfactory. CONCLUSION Employing the anterior neurovascular interval approach for open reduction and internal fixation to manage coronoid process fractures effectively facilitates anatomical restoration and robust fixation of ulnar coronoid process fractures.
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Affiliation(s)
- Fei Yang
- Department of Orthopedics, Sir Run Run HospitalNanjing Medical UniversityNanjingChina
| | - Zeyong Wang
- Department of Orthopedics, Sir Run Run HospitalNanjing Medical UniversityNanjingChina
| | - Tangbo Yuan
- Department of Orthopedics, Sir Run Run HospitalNanjing Medical UniversityNanjingChina
| | - Jian Qin
- Department of Orthopedics, Sir Run Run HospitalNanjing Medical UniversityNanjingChina
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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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Makihara K, Takeda S, Mitsuya S, Yamauchi KI. Surgical fixation of ulnar coronoid process fractures via mesh plate: A case report. Trauma Case Rep 2022; 39:100634. [PMID: 35340356 PMCID: PMC8942840 DOI: 10.1016/j.tcr.2022.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The coronoid process of the ulna is the primary stabilizer of the elbow joint. There has not yet been an accurate off-the-shelf dedicated implant because fragments of coronoid process fractures are often small and diverse. The variable angle locking compression mesh plate 2.4/2.7 (Depuy Synthes, West Chester, PA, USA) acts as a versatile, low-profile implant that can be cut to suit the specific fracture pattern and fits anatomically. Case presentations We report two cases of Regan–Morrey type II ulnar coronoid process fractures in terrible triad elbow injuries. In both cases, persistent instability was fluoroscopically diagnosed after repair of the lateral structures. We performed osteosynthesis for the ulnar coronoid process fractures using a mesh plate, which we cut into a rhombus-like shape and used as a buttress plate. Here we report the good results obtained thereof. Conclusion Considering our positive experience with using mesh plates, the mesh plate may be a good method of fixation for ulnar coronoid process fractures.
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Cucchi D, Luceri F, Menon A, Müller LP, Kabir K, Randelli PS, Arrigoni P, Wegmann K. Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint. Arch Orthop Trauma Surg 2022; 142:813-821. [PMID: 33484309 PMCID: PMC8994731 DOI: 10.1007/s00402-021-03753-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/01/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Preventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation. MATERIALS AND METHODS The median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90° flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination. RESULTS The distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position. CONCLUSIONS The ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Francesco Luceri
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, Milan, 20122, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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王 刚, 章 乐, 张 月. [Treatment of ulnar coronoid process fracture via a modified anteromedial approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:826-830. [PMID: 32666723 PMCID: PMC8180416 DOI: 10.7507/1002-1892.201912012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/28/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. METHODS Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). RESULTS All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. CONCLUSION The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.
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Affiliation(s)
- 刚 王
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopaedic Trauma, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - 乐成 章
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopaedic Trauma, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - 月雷 张
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopaedic Trauma, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China
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