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Bašković M, Pešorda D, Zaninović L, Hasandić D, Lohman Vuga K, Pogorelić Z. Management of Pediatric Elbow Fractures and Dislocations. CHILDREN (BASEL, SWITZERLAND) 2024; 11:906. [PMID: 39201841 PMCID: PMC11352739 DOI: 10.3390/children11080906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024]
Abstract
Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Domagoj Pešorda
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Luca Zaninović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Damir Hasandić
- Department of Pediatric Surgery, Clinical Hospital Center Rijeka, Vjekoslava Dukića 7, 51000 Rijeka, Croatia
- School of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Katarina Lohman Vuga
- Special Hospital for Medical Rehabilitation Varaždinske Toplice, Trg Svetog Martina 1, 42223 Varaždinske Toplice, Croatia
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva ulica 1, 21000 Split, Croatia
- School of Medicine, University of Split, Šoltanska ulica 2a, 21000 Split, Croatia
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Gao X, Li H, Xue D, Pan Z, Zhang Y. Clinical outcomes of capitellar fractures with posterior comminution treated with Herbert screws combined with metacarpal locking plates. BMC Musculoskelet Disord 2023; 24:937. [PMID: 38044433 PMCID: PMC10694941 DOI: 10.1186/s12891-023-07065-7] [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: 08/08/2022] [Accepted: 11/25/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The treatment of Dubberley type B capitellar fractures, which are frequently complicated, is widely debated. This study aimed to investigate the prognostic factors and clinical outcomes of Dubberley type B capitellar fractures treated with Herbert screws combined with posterior buttress plates. METHODS Seven men and nine women (aged 30-68 years) with Dubberley type B capitellar fractures were operated on with Herbert screws combined with posterior buttress plates. The patients were classified into Dubberley types IB (seven), IIB (four), and IIIB (five). Complications and bone union were observed, and functional outcomes were evaluated by the Mayo Elbow Performance Index (MEPI). RESULTS All patients were followed up for a mean period of 23.5 months (12-30 months). All fractures healed in 8-14 weeks (mean, 10.5 weeks). No cases of non-union, elbow instability, or avascular necrosis occurred. Degenerative arthritis occurred in 7 (44%) and heterotopic ossification in 11 (69%) patients. The median MEPI score was 92.5 (interquartile range, 85-100) points, with 11 reporting excellent, 3 good, and 2 fair outcomes. The MEPI scores of type IIIB fractures were significantly lower than those of types IB and IIB fractures, while the MEPI scores of type IB and IIB fractures did not differ significantly. CONCLUSIONS Dubberley type IIIB capitellar fractures with multiple articular fragments have a poorer prognosis than type IB and IIB fractures. However, Herbert screw fixation combined with posterior metacarpal locking plates is feasible, providing satisfactory recovery of elbow joint function.
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Affiliation(s)
- Xiang Gao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Hang Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Deting Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhijun Pan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yujie Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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Ishizaka K, Moriya K, Yamamoto K, Matsuyama Y, Koda H, Tsubokawa N. Distal humeral osteotomy combined with posterior olecranon osteotomy approach for coronal shear fracture of the distal humerus: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:256-259. [PMID: 37588445 PMCID: PMC10426633 DOI: 10.1016/j.xrrt.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Koji Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | | | | | - Hisao Koda
- Niigata Hand Surgery Foundation, Niigata, Japan
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Cao C, Xing H, Cao F, Du Z, Wang G, Wang X. Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report. Medicine (Baltimore) 2023; 102:e32507. [PMID: 36637956 PMCID: PMC9839266 DOI: 10.1097/md.0000000000032507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Because of the complicated anatomy and considerable change in size and morphology with age in teenagers, the appropriate internal fixator of coronal shear fracture of distal humerus is difficult to choose, and therefore, the fixation of this kind of fracture is difficult and controversial. Furthermore, distal humeral fractures in teenagers often involve the epiphysis, the rigid fixation of fracture and the simultaneous minimally invasive and protection of the epiphysis are contradictory. Coronal shear fractures of the distal humerus in teenagers are great challenge for orthopedic surgeons. Three-dimensional (3D) printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager is a potential satisfactory choice in the treatment of the complex fractures. PATIENT CONCERNS A teenager suffered from an elbow joint injury due to a fall while running, resulting in pain, swelling and limited movement of the elbow joint. The epiphyseal has not closed in this patient, conventional surgical procedures have great traumatic and invasive, and to some extent affect bone growth in children. DIAGNOSES Coronal shear fracture of right distal humerus according to computed tomography scan. INTERVENTIONS We used 3D printing technology to design an internal fixation device for this patient, which was to treat the distal humeral coronal shear fracture in a teenager via an anterior approach to the elbow joint, and finally the child was instructed to perform immediate postoperative functional exercises and rehabilitation. OUTCOMES Radiographic reexamination performed 1 day and 2 month after the operation showed that the internal fixation was in good position, no fracture displacement. the patient was instructed to perform active flexion and extension internal and external rotation of the right elbow 6 weeks postoperatively. The Mayo elbow function score was excellent 5 months postoperatively. The range of motion of the elbow was (15°-130°). LESSONS The treatment of coronal shear fractures of the distal humerus in teenager is controversial at present. This report 3D printing technology designed customized plate in treatment of such fractures showed satisfactory results, which provides a feasible method for the treatment of fractures without suitable internal fixation devices in the future.
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Affiliation(s)
- Changpeng Cao
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Haiyang Xing
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Faxin Cao
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Zhipeng Du
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Gang Wang
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
- * Correspondence: Gang Wang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun City, Jilin Province, China (e-mail: )
| | - Xiyao Wang
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
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Vicenti G, Bizzoca D, Zaccari D, Buono C, Carlet A, Solarino G, Giorgino R, Santolini E, Lunini E, Zavattini G, Ottaviani G, Carrozzo M, Simone F, Marinelli A, Rotini R, Franchini A, Moretti B. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members. Injury 2022; 54 Suppl 1:S78-S84. [PMID: 36400627 DOI: 10.1016/j.injury.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs. RESULTS 114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%). CONCLUSION An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Arianna Carlet
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enricomaria Lunini
- Orthopedics and Trauma Unit, ASST Lariana Ospedale Sant'Anna, Como, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Filippo Simone
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Franchini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Nakamura Y, Tsubo K, Sasaki N, Ichikawa N, Tsukada H, Yamasaki Y, Ishibashi Y. Conservative treatment for coronal shear fracture of the distal humerus: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:580-583. [PMID: 37588458 PMCID: PMC10426705 DOI: 10.1016/j.xrrt.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Yuzuru Nakamura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenji Tsubo
- Department of Orthopaedic Surgery, Fuyoukai Murakami Hospital, Aomori, Japan
| | - Norihiro Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nana Ichikawa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Harehiko Tsukada
- Department of Orthopaedic Surgery, Aomori City Hospital, Aomori, Japan
| | | | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Capitellum and trochlea fractures. A systematic review of the literature. J Clin Orthop Trauma 2022; 31:101922. [PMID: 35789821 PMCID: PMC9249815 DOI: 10.1016/j.jcot.2022.101922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/16/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the outcome of capitellum and trochlea fractures through a systematic review of the contemporary literature. The effect on the outcome, of the posterolateral column comminution and the surgical approach used for fixation, was also evaluated. METHODS PUBMED, SCOPUS and MENDELEY databases were searched for capitellum and trochlea fractures and a systematic review was conducted according to PRISMA guidelines. The minimum one year clinical outcome and the flexion extension arc of these fractures, as well as the risk of developing degenerative arthritis were evaluated. The studies included to the meta - analysis were assessed based on the Newcastle Ottawa score. A fixed effect model was performed to compare the outcome and range of motion among Dubberley type A and type B fractures as well as between the extended lateral approach and the posterior transolecranon approach which were performed for Dubberley type B fractures. Furthermore the relative risk of degenerative arthritis (DA) among type A and type B fractures was also estimated. Chi square test was used to test heterogenity among studies. RESULTS Ten nonrandomized case series were eligible to our inclusion criteria, including 76 patients in total. The fixed overall Mayo Elbow Performance Score (MEPS) and the Range of Motion (ROM) of the Dubberley type A fractures was 86 (95% C.I.: 85,1-86,9) and 124 0 (95% C.I.: 122 0-124 0) respectively. The fixed overall MEPS and ROM of the Dubberley type B fractures was 84 (95%C.I.: 79,9-88,1) and 122 0 (95% C.I.: 120 0-123 0) respectively. Significant heterogenity was found though between studies regarding MEPS of type B fractures. The fixed overall MEPS and ROM for fractures treated with an extended lateral approach was 89,4 (95% C.I.: 85,36-93,44) and 123 0 (120 0-126 0) respectively. The fixed overall MEPS and ROM for fractures treated with a posterior transolecranon approach was 68,75 (95% C.I.: 67,89-69,6) and 122 0 (114 0-130 0) respectively. The degenerative arthritis relative risk (RR) of type B compared to type A fractures was 3,91 (95% C.I.: 0,84-18,13). CONCLUSION There is no statistically significant difference among type A and type B fractures, in terms of outcome and ROM. The posterior transolecranon approach leads to a lower MEPS as opposed to the extended lateral approach. High quality studies comparing directly the outcome of type A and type B fractures are required, in order for safe conclusions to be extracted.
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Teraura H, Gotani H, Sakanaka H. Modified Posterior Trans-olecranon Approach in Tri-vision for Dubberley Type 3B Coronal Shear Fractures of the Distal Humerus. Cureus 2022; 14:e25175. [PMID: 35607317 PMCID: PMC9123390 DOI: 10.7759/cureus.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/05/2022] Open
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Coronal Shear Fractures of the Distal Humerus. J Funct Morphol Kinesiol 2022; 7:jfmk7010007. [PMID: 35076551 PMCID: PMC8788494 DOI: 10.3390/jfmk7010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.
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Shergold S, Derias M, Moverley R, Murphy RJ, Guryel E, Phadnis J. Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System. J Shoulder Elbow Surg 2022; 31:133-142. [PMID: 34390839 DOI: 10.1016/j.jse.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronal shear fractures of the capitellum and trochlea are relatively uncommon and can be challenging to treat because of variable articular comminution and poor bone stock. Classification is valuable to help guide surgical decision making and prognosis. The aim of this study was to present a large series of coronal shear fractures treated according to the Modified Dubberley Classification System (MDCS). METHODS Forty-five patients with a coronal shear fracture were followed up (12-93 months, mean: 28 months) after surgical intervention. Fractures were classified according to the MDCS by 3 observers, and outcome data collected included Oxford elbow score (OES), visual analog pain score (VAS), range of motion, complications, and radiographic findings. RESULTS There were 10 type 1, 12 type 2, 8 type 3, and 15 type 4 fractures. There were 26 subtype B fractures (posterior comminution). A total of 37 patients underwent open reduction and internal fixation (ORIF) and 8 primary arthroplasty. The median OES and VAS were 43(16-48) and 2 (0-9), respectively. Median flexion extension arc was 125° (range, 70°-140°). There was no significant difference in OES, VAS, or range of motion according to fracture type (types 1-4), subtype (type a or b), or treatment method (arthroplasty vs. ORIF). The overall complication and reoperation rates were 31% and 33%, respectively. A total of 75% of complications occurred in type 3 and 4 fractures, and there was a nonsignificant trend toward higher complication rate in type B fractures than type A fractures (34% vs. 16%, P = .19). Patients with a type B fracture who underwent screw-only fixation had a significantly lower OES and higher complication rate compared with when they had combined plating with screws (OES, P = .03; complications P = .04) and compared with when an arthroplasty was performed (OES, P = .05; complications P = .04). CONCLUSION Consistently good outcomes can be achieved by classification and management according to the MDCS. It is recommended that type B fractures undergo combined plate and screw fixation and that type 4 fractures should be considered for arthroplasty because of the higher risk of complications with ORIF.
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Affiliation(s)
- Sophie Shergold
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mina Derias
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Robert Moverley
- University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, Dorset, UK
| | - Richard J Murphy
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
| | - Enis Guryel
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Joideep Phadnis
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
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Calderazzi F, Schiavi P, Pogliacomi F, Tacci F, Vaienti E, Ceccarelli F. Involvement of the medial and lateral epicondyles in distal humeral coronal shear fractures: Case series and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1341-1356. [PMID: 34514547 DOI: 10.1007/s00590-021-03113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Epicondyle involvement in capitellar and trochlear fractures is often considered a simple associated lesion that does not substantially change treatment or prognosis. Although theoretically predicted in reviews, case series almost never report elbow prosthesis use in comminuted coronal shear injuries associated with epicondylar fracture in the elderly. The purpose of this study is to focus on this underestimated injury pattern that can be a negative risk factor for treatment and prognosis. METHODS We retrospectively reviewed all cases with coronal shear fracture of the distal humerus treated from 2016 to 2019. Fractures were classified according to Dubberley. Open reduction and internal fixation (ORIF) were performed when possible. Partial or total elbow replacement was used in severely comminuted fractures with epicondylar involvement in four elderly patients. RESULTS Nineteen consecutive patients were selected (mean age: 62.4 years), of which 10 had type 3A/3B fractures, and seven had both medial and lateral epicondylar involvement. The mean follow-up duration was 31.78 months. The average Mayo Elbow Performance Index (MEPI) score was 81.05 points, with 7 excellent, 8 good, 1 fair, and 3 poor results. The average MEPI score of Dubberley's type 1 and type 2 was better than that of type 3 (mean: 92 vs. 72, p = 0.02). Further, the results of average range of motion were better in patients who had sustained Dubberley types 1 and 2 lesions than those with Dubberley type 3 lesion (mean: 133° vs. 85°, p = 0.002). Two patients out of three who required intra-operative conversion to total elbow arthroplasty had poor outcomes. CONCLUSIONS The simultaneous presence of fracture of one or both epicondyles are usually associated with severe joint comminutions and makes ORIF more challenging, especially among elderly women. In these cases, primary total elbow prosthesis implantation could be a valid treatment option.
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Affiliation(s)
- Filippo Calderazzi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy.
| | - Paolo Schiavi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Francesco Pogliacomi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Fabrizio Tacci
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Enrico Vaienti
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Francesco Ceccarelli
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
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Lu Y, Fu L, Ma T, Xu YB, Xu LP, Song Z, Fan S, Wang Q, Sun L, Xue HZ, Li Z, Zhang K, Liu DY, Ren C. Clinical Efficacy of Vertical or Parallel Technique of a Micro-Locking Plate for Treatment of Dubberley B-Type Capitellar Fractures. Orthop Surg 2021; 13:207-215. [PMID: 33426763 PMCID: PMC7862171 DOI: 10.1111/os.12880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical efficacy of micro‐locking plate through vertical or parallel technique for treatment of Dubberley B‐type capitellar fractures. Methods A retrospective analysis was performed in 24 patients (17 males and seven females, with an average age of 44.9 years, range from 19 to 75 years) with capitellar fractures that were treated with micro‐locking plate using vertical or parallel technique between January 2016 to January 2019. The inclusion criteria include closed capitellar fracture, normal anterior elbow joint movement before injury, and recent capitellar fracture with injury within past 3 weeks. Fractures classified according to Dubberley included four cases of type IB, eight cases of type IIB, and 12 cases of type IIIB. Radiographic evaluation was performed. Surgery time, blood loss, range of motion of the elbow, forearm rotation, and complications were recorded. Elbow joint function was evaluated by Mayo Elbow Performance Score (MEPS). Results The mean follow‐up period was 19.6 months (range, 12–36 months). The average clinical healing time for fractures was 11.2 ± 3.2 weeks (range, 8–20 weeks). Fracture united in all patients. Two patients showed slight delayed union, but union was achieved eventually. The mean time from injury to surgery was 6.3 ± 3.1 days (range, 2–15 days). The average surgical time was 68.1 ± 11.5 min (range, 50–90 min), and the mean blood loss was 75.2 ± 26.5 mL (range, 40–120 mL). The mean range of flexion was 122.5° ± 10.5°(range, 95°–140°). The mean range of extension was 8.5° ± 5.8°(range, 0°–20°). The mean range of pronation was 79.7° ± 8.0°(range, 65°–90°). The mean range of supination was 80.5° ± 7.1°(range, 60°–90°). The mean MEPS at final follow‐up was 89.8 ± 9.0 (range, 60–100). Based on the MEPS, 18 (75%) patients had excellent, five (20.8%) patients had good, and one (4.2%) patient had fair. None of the 24 patients suffered vascular or nerve injury. One patient showed superficial infection, which was treated with surgical dressing. Conclusions The vertical or parallel technique of the micro‐locking plate is an excellent method for treating Dubberley B‐type capitellar fractures.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lei Fu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yi-Bo Xu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Li-Ping Xu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Zhe Song
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shan Fan
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Han-Zhong Xue
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - De-Yin Liu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
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13
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Teng L, Zhong G. Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus. Orthop Surg 2020; 12:1439-1447. [PMID: 32979039 PMCID: PMC7670145 DOI: 10.1111/os.12765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. METHODS From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19-72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow-up was evaluated by Mayo Elbow Performance Score (MEPS). RESULTS All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow-up, the elbow flexion-extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexion- extension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002). CONCLUSION Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.
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Affiliation(s)
- Lin Teng
- Department of OrthopedicsThe First People's Hospital in Shuangliu District/West China Airport Hospital, Sichuan UniversityChengduChina
| | - Gang Zhong
- Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
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14
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Abdoli A, Farhoud AR, Kamrani RS. Treatment of Distal Humerus Articular Fracture with Pin-and-Plate Technique. J Hand Surg Asian Pac Vol 2020; 25:332-339. [PMID: 32723041 DOI: 10.1142/s242483552050037x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Distal Humerus Articular Fracture (classified by Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association as 13-B3) is an uncommon fracture with significant complications. We report results of 14 patients treated by open reduction and pin-and-plate fixation technique. Methods: In this retrospective study, we applied pin-and-plate fixation to 14 distal humerus articular fractures, in which screw fixation alone was inefficient or inadequate to provide stable fixation. After anatomical reduction of articular fragments, multiple Kirschner wires were inserted through the fragments. To prevent migration of Kirschner wires a small plate was placed proximally on the bent end of the pins. Results: The average age of 14 patients (8 males and 6 females) was 36.4 years (range: 16-57) and the mean follow up period was 43 months (range: 12-80). At last follow up the average quick Disabilities of the Arm, Shoulder and Hand score was 18.9 (range: 2.3-42.5) and the mean points for Mayo Elbow Performance Index was 75.3 (range: 50-100). Mean final arc of flexion-extension was 97° (range: 40-131). Conclusions: Distal humerus articular fracture is sometimes difficult to fix with conventional methods. We used pin-and-plate technique that could make a stable fixation and allow early range of motion with acceptable results.
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Affiliation(s)
- Abbas Abdoli
- Department of Orthopedics, Shahid Sadoughi Hospital, Shahaid Sadoughi (Yazd) University of Medical Sciences, Yazd, Iran
| | - Amir Reza Farhoud
- Department of Orthopedics, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Joint Reconstruction Research Center, Tehran, Iran
| | - Reza Shahryar Kamrani
- Joint Reconstruction Research Center, Tehran, Iran.,Department of Orthopedics, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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15
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Sun Y, Thanomsingh P, Jeon IH. Coronal shear fracture of distal humerus associated with olecranon fracture: A case report and pathomechanism. J Orthop Surg (Hong Kong) 2020; 27:2309499019849707. [PMID: 31130063 DOI: 10.1177/2309499019849707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Distal humeral coronal shear fractures are rare and account for around 1% of all fractures at the elbow level and 6% of the distal humeral fractures. Many studies have reported on the associated injuries involving the lateral collateral ligament injuries and radial head fractures in up to 40% and 30% of humeral fractures, but this combination of coronal shear fracture of the trochlea and capitellum associated with olecranon fracture is unusual. Here, we report two cases of distal humerus coronal shear fracture with olecranon fracture treated surgically and establish and discuss the pathomechanisms, diagnosis, and therapeutic issues relating to this fracture.
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Affiliation(s)
- Yucheng Sun
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.,2 Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Pachin Thanomsingh
- 3 Department of Orthopaedics, Maharat Nakhon Ratchasima Hospital, Nakhorn Ratchasima, Thailand
| | - In-Ho Jeon
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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16
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Song Z, Wang Q, Ma T, Wang C, Yang N, Xue H, Li Z, Zhu Y, Zhang K. Anti-sliding plate technique for coronal shear fractures of the distal humerus. J Orthop Surg Res 2020; 15:18. [PMID: 31952529 PMCID: PMC6969457 DOI: 10.1186/s13018-019-1466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. METHODS Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. RESULTS Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0-15°) for extension and 136° (90-150°) for flexion. CONCLUSIONS The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Zhe Song
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Chen Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Na Yang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Zhong Li
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China.
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Yang XH, Wei C, Li GP, Wang JJ, Zhao HT, Shi LT, Cao XY, Zhang YZ. An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up. Rev Assoc Med Bras (1992) 2019; 65:355-360. [PMID: 30994833 DOI: 10.1590/1806-9282.65.3.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 01/30/2023] Open
Abstract
SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.
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Affiliation(s)
- Xiao-Hua Yang
- Affiliated Hospital of Chengde Medical College, China
| | | | - Guo-Ping Li
- Affiliated Hospital of Chengde Medical College, China
| | - Jian-Ji Wang
- Affiliated Hospital of Chengde Medical College, China
| | - Hai-Tao Zhao
- Affiliated Hospital of Chengde Medical College, China
| | - Li-Tao Shi
- Affiliated Hospital of Chengde Medical College, China
| | - Xiang-Yu Cao
- Affiliated Hospital of Chengde Medical College, China
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Schmidt I. A Complicated Course of a Coronal Shear Fracture Type IV of the Distal Part of Humerus Resulting in Resurfacing Radiocapitellar Joint Replacement. Open Orthop J 2017; 11:248-254. [PMID: 28567152 PMCID: PMC5420185 DOI: 10.2174/1874325001711010248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Coronal shear fracture type IV of the distal part of humerus is a very rare injury with articular complexity potentially leading to posttraumatic osteoarthritis. One option for surgical treatment of advanced unicompartmental radiocapitellar osteoarthritis is resurfacing radiocapitellar joint replacement. Method: A 62-year- old female sustained a coronal shear fracture type IV of the distal part of left humerus that was primarily treated with open reduction and internal fixation using headless compression screws. Three years postoperatively, there was a migration of one screw into radiocapitellar joint that led to circular deep cartilage defect of radial head. Four years after ORIF, a distinctive radiocapitellar osteoarthritis has evolved leading to a resurfacing radiocapitellar joint replacement using the Lateral Resurfacing ElbowTM (LRE) system. Result: At the 2-year follow-up after that procedure, there was an excellent subjective and functional outcome. Radiographically, no loosening or subsidence of implant without any signs of overstuffing could be found. The patient reported that she would have the same procedure again. Conclusion: The goal of unicompartmental radiocapitellar replacement is to obtain stability in elbow joint by avoiding cubitus valgus with subsequent instability of the distal radioulnar joint, and it does not alter the unaffected ulnohumeral joint. Additionally, the feature of the LRETM system is that the radial head is not excised, and so will receive the anatomical length of the overall radius articulating with the capitellum by preserving the annular ligament. In the literature only three publications could be found in which short-term results with the use of the LRETM system have been described. Hence, further studies are needed to validate this concept.
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Affiliation(s)
- Ingo Schmidt
- SRH Poliklinik Gera Gmbh, Straße des Friedens 122, Gera 07548, Germany
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19
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Ravishankar MR, Kumar MN, Raut R. Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:233-242. [DOI: 10.1007/s00590-016-1877-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/22/2016] [Indexed: 01/02/2023]
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20
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Singh AP, Singh AP. Coronal shear fractures of distal humerus: Diagnostic and treatment protocols. World J Orthop 2015; 6:867-876. [PMID: 26716083 PMCID: PMC4686434 DOI: 10.5312/wjo.v6.i11.867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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