Coronal Fracture Research Articles

Rare case of medial Hoffa fracture with ipsilateral femur shaft fracture with unusual mechanism of injury

Hoffa’s fracture is a rare fracture which involves coronal fracture of the distal femur involving one or both the condyles. We report a rare combination of Hoffa fracture with ipsilateral femur shaft fracture with an unusual mechanism of injury. This case report will help increase awareness about such combined fracture pattern and eventually avoid missing these important intra-articular injuries- Hoffa’s fracture. In a patient with ipsilateral femur shaft fracture and in polytrauma patients, diagnosis of Hoffa’s fracture is very challenging because of presence of other long bone fracture and injuries. Missed Hoffa’s fracture in a patient with ipsilateral femur shaft fracture may restrict post-operative knee range of motion, knee pain, increased risk of early arthritis and joint deformity and stiffness.

Knowledge and Practice of Iranian Dentists Regarding Post Space Preparation and Coronal Reconstruction of Endodontically Treated Teeth

Background: Due to severe coronal destruction in endodontically treated teeth (ETT), the canal space is often utilized to provide retention for the core material. Objectives: This study aimed to assess the knowledge level and practices of Iranian dentists regarding post space preparation and coronal reconstruction of ETT. Methods: This cross-sectional study was conducted with 117 dentists at Kurdistan University of Medical Sciences in 2021. Data were collected using a two-part questionnaire. The first part included 6 questions regarding the demographic information of the participants. The second part comprised 10 questions regarding the methods of post space preparation and coronal reconstruction of ETT. SPSS-20 software was used to analyze the data, calculating frequency (%), mean, and standard deviation. Results: 44.4% of the participants used amalgam along with a prefabricated post, 59% correctly identified the definition of the ferrule effect, and 87.2% believed that the ferrule effect increases fracture resistance. Additionally, 39.3% reported preparing the post space immediately after obturation; 91.5% used rotary instruments for removing root filling material, 93.2% reported cleaning the post space prior to cementation of the intracanal post, and 35.9% used saline for this purpose. Moreover, 72.9% believed that teeth with post and core necessarily require a prosthetic crown, and 94% used full-coverage crowns for ETT. Coronal fracture was reported by 62.4% as the most common cause of failure of ETT. Conclusions: The knowledge level of dental clinicians regarding post space preparation and coronal reconstruction of ETT was moderate, while their practice level was poor. The most common variables that had a significant relationship were age and academic degree.

Restoration of fractured anterior tooth with monochrome composite resin in pediatric dental patient

Direct restoration with monochromatic composite resin is a treatment option for teeth with coronal fracture after dentoalveolar trauma. This restorative material, in principle, is capable of mimicking the color of the dental substrate. This study aimed to report and discuss the technique of direct restoration with monochromatic composite resin, in a child patient. An 8-year-old male patient attended the Emergency Room of the Baby Clinic of the State University of Londrina for immediate treatment after dentoalveolar trauma that resulted in enamel and dentin fracture, without pulp involvement. As a procedure, restoration was performed with glass ionomer cement and referral to the institution's Dental Residency program. In this service, after case planning, the restoration of the coronal fracture of the substrates was performed with the insertion of multiple increments of the Vittra APS Unique (FGM) composite, with the aid of a silicone guide prepared based on a waxing model to facilitate the reestablishment of the palatal surface form and anatomy. In the clinical follow-up evaluation, the aesthetic and functional results obtained were considered highly satisfactory by patients, relatives and dental clinicians. Thus, it can be concluded that the option for monochromatic composite resin is a viable alternative to make it easier for the dental clinicians to perform the procedure and reduce the clinical time, a relevant fact because it is a case of caring for a pediatric dentistry patient.

Reattachment of Fractured Tooth Segment in Minimally Invasive Way - A Case Report

Dental trauma frequently results in coronal fractures of the front teeth. Root canal therapy followed by reattaching the fractured segment with fiber post reinforcement is a viable alternative in cases of complex fractures where the fractured segment is present and there is close approximation of the segment to the intact tooth. Reattaching a fractured piece is a quicker, less involved process that offers immediate relief, better aesthetics, and function restoration. The present case report is of a 11-year-old boy with an uncomplicated crown fracture of permanent maxillary right central incisor and a palatal uncomplicated crown–root fracture of his permanent maxillary left central incisor . The fractured fragment was reattached using nano-filled dual-cure composite resin and tooth restored with composite resin. The fragment showed opaque discoloration that reduced over time but still persisted after 1 year. During the follow-up period, no unfavorable radiographic changes were seen. The prognosis of the teeth was favorable with good esthetic results. Keywords: Fragment reattachment, Fragment rehydration, Periodontal health, Root fracture, Uncomplicated crown.

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options?

Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.

Elbow hemiarthroplasty for coronal shear fractures of the distal humerus

The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus. Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided. Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis. Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through aparatricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired. Early functional rehabilitation in ahinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed. Between 2018 and 2022, 18patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after amean follow-up of 12months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.

Fracture Lines and Patterns in Intra-articular Distal Femur Fractures.

Distal femur fractures are complex injuries that often present with multiple fragments, posing notable challenges to fixation. This study aimed to (1) use preoperative CT scans to graphically display fracture lines in intra-articular distal femur fractures and (2) identify common fracture patterns in these injuries. All skeletally mature patients that underwent surgical fixation of Orthopaedic Trauma Association type 33C distal femur fractures between 2012 and 2022 were identified across two level 1 trauma centers (n = 63). Preoperative axial, sagittal, and coronal computed tomography scans were obtained. Fracture lines in each plane were traced out and superimposed on standardized distal femur cross-sections, generating a fracture map for each plane. Injury and fracture characteristics were summarized and compared between fracture patterns. On axial scans, 59 of 63 fractures contained a central intercondylar split from the intercondylar notch to the trochlea. On coronal scans, fracture lines originated at the notch and exited laterally and medially in the supracondylar region, creating a Y-shape. One-third of all fractures contained coronal fracture lines, with most involving the lateral condyle. Based on fracture line orientation and location, fractures were divided into four main fracture pattern types. Type 4 fractures (central split and medial coronal fracture line) were associated with lower average medial fracture height and a lower rate of medial metaphyseal comminution. We found that C-type distal femur fractures can present with four main fracture patterns. Most fractures contain a central sagittal intercondylar split, and a high proportion of fractures contain either medial or lateral coronal fracture lines. Fracture pattern was associated with mechanism of injury, presence of medial comminution, and medial fracture line height. Future studies should focus on clinical outcomes and surgical management of these distinct fracture patterns. IV.

Classification of Hamate Fractures: An Analysis of 247 Patients with Hamate Fractures.

Background: We devised a new classification of hamate fractures named the TOUCH classification. Each letter of this acronym depicts a fracture type - Type I (Transverse fracture), Type II (Open and/or complex fracture), Type III (Ulnar/medial tuberosity fracture), Type IV (Coronal fracture) and Type V (Hook fracture). Each fracture type was further divided into two or three subtypes (a, b, and/or c) based on degree of severity. The aim of this study is to classify the hamate fractures treated at our centre using this classification. Methods: A retrospective review of all patients with hamate fractures treated at our hospital between 2003 and 2022 was done. Patient data with regard to age, gender, mechanism of injury, injured limb and any associated injuries was collected. Hamate fractures were classified based on the TOUCH classification. Results: A total of 247 patients with hamate fractures were included. Patients in the age group of 20-40 years accounted for 73.6% of all fractures. Female patients accounted for only 6.9% of all fractures and 76.5% of women with hamate fractures were older than 40 years. The incidence of hamate fracture tended to increase with age in women. The most common mechanism of injury was a fall (69 patients). The injury involved the right upper limb in 195 patients. And 164 patients had associated injuries in the same upper limb. Type III (coronal fracture of the hamate body) accounted for 57.4%, followed by type V (hook of hamate fracture) in 26.7% of patients. Conclusions: The TOUCH classification could cover all kinds of hamate fractures. It is easy to remember and may guide surgeons in considering treatment options. Level of Evidence: Level IV (Diagnostic).

Highly extensile approach for comminuted ulna coronoid process fractures with mini-plate fixation: a case series of 31 patients

BackgroundFor 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.MethodsThirty-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.ResultsThe 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.ConclusionAn 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.

Minimum four-year clinical outcomes after on-table reconstruction technique for Dubberley type III in coronal shear fractures of the capitellum and trochlea: a report of 10 patients

PurposeComminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures.MethodsA retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an ‘on-table’ reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later.ResultsAll cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3–32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70–100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment.ConclusionThe on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up.Level of evidenceLevel IV, retrospective case series.

Medial Femoral Trochlea Osteochondral Flap Reconstruction of the Previously Unsalvageable Kienbock-Associated Lunate With a Coronal Split

Patients with Kienbock disease can present with coronal fracture and collapse of the proximal lunate (Unified B2/Bain grade 1, 2B). Traditionally, this was considered unsalvageable. However, medial femoral trochlea (MFT) osteochondral reconstruction, used to recreate the proximal lunate surface, can be paired with reduction and repair of the coronal plane fracture, thus restoring midcarpal congruity. The purpose of this study was to report radiographic and clinical outcomes following lunate coronal fracture fixation at the time of MFT osteochondral reconstruction. This was a retrospective study performed at a single institution. We identified patients with Kienbock disease who underwent MFT osteochondral reconstruction from 2014 to 2023. Patients were included if they had a coronal fracture of the lunate distal articular surface fixed at the time of surgery. Radiographic and clinical parameters were evaluated, including carpal height ratio, union rate, presence of heterotopic ossification, need for revision surgery, and patient-reported outcome measures. Thirty-three patients were included, with a mean age of 27.5 years (range: 15-41); 19 (58%) were women. Mean radiographic follow-up time was 5.8 months, and mean clinical follow-up time was 22.6 months. Union was achieved in 30/33 patients (91%). Carpal height ratio improved from 1.32 to 1.4. Two patients (6%) required reoperation, one for removal of heterotopic ossification and another for conversion to proximal row carpectomy. Patients demonstrated meaningful improvement in brief Michigan Hand Questionnaire and Patient-Reported Outcomes Measurement Information Upper Extremity scores. Range of motion before and after surgery was similar. Lunate coronal fracture fixation with MFT osteochondral reconstruction represents an additional management option in select patients with Kienbock disease. This technique restores the midcarpal joint during lunate reconstruction and may allow patients to avoid salvage procedures. Early radiographic and clinical outcomes are promising. Therapeutic IV.

Comparison of tibial fracture plate length, placement, and fibular integrity effects on plate integrity through finite element analysis

Minimally invasive plate osteosynthesis is the most commonly used minimally invasive surgery technique for tibial fractures, possibly involving single or dual plate methods. Herein, we performed a finite element analysis to investigate plate strength according to the plate type, length, and presence of a fibula by constructing a three-dimensional tibia model. A thickness of 20 mm was cut 50 mm distal from the lateral plateau, and the ligaments were created. Plates were modeled with lengths of 150, 200, and 250 mm and mounted to the tibia. Screws were arranged to avoid overlapping in the dual plating. The von-Mises stress applied to the plates was measured by applying a load of 1 body weight. Dual plates showed the least stress with low displacement, followed by medial and lateral plates. As the plate length increased, the average stress gradually decreased, increasing plate safety. The difference in the influence of the fibula depending on the presence of proximal fibula osteotomy showed that the average stress increased by 35% following proximal fibula osteotomy in the D1(Plate type: Dual plate, Medial plate length: 150 mm, Lateral plate length: 200 mm, Non Proximal fibula osteotomy) and D1P(Plate type: Dual plate, Medial plate length: 150 mm, Lateral plate length: 200 mm, Proximal fibula osteotomy) models, confirming the necessity of the fibula model. There is no consensus guideline for treatment of this kind of fracture case. A single fracture plate can decrease the risk of skin damage, ligament damage, and wound infection, but because of its design, it cannot provide sufficient stability and satisfactory reduction of the condylar fragment, especially in cases of comminution or coronal fracture. So, these results will help clinicians make an informed choice on which plate to use in patients with tibial fractures.

Guided bone regeneration and implantological surgery in patients with a complicated alveolar dental trauma. A case report

Background: The difficulty of dental restoration varies depending on the factors that caused the loss or destruction of the original tissue, the major cause of dental rehabilitation is trauma fracture being more common in young people, these fractures can be restored or cause tooth extraction, in those cases where trauma causes tooth extraction various factors such as density and state of bone contour play an important role when what is wanted is a rehabilitation by dental implant, This is why different techniques and bone graft materials are combined with platelet-rich fibrin to increase the success rate.Objective: To show the clinical management of a patient with complicated alveolar trauma, exposing the surgical protocol, using two types of bone grafts and collagen membranes. Case Report: Fema- le patient comes to a consultation with a history of complicated dentoalveolar trauma 1 month before care, presents complicated coronal fracture of 12, 21 and 22, It was decided to perform surgical procedure with bone graft in combination with collagen membrane. Results: The patient developed favorably, obtaining the desired aesthetic and functional results. Conclusion: The application of guided bone regeneration treatment and implant surgery as performed in the reported case was a favorable and innovative option for oral rehabilitation. After 1 year of follow-up of the case, implant and peri-implant stability is evidenced in the use of two types of grafts.

Fragment size of lateral Hoffa fractures determines screw fixation trajectory: a human cadaveric cohort study.

Recommendations regarding fragment-size-dependent screw fixation trajectory for coronal plane fractures of the posterior femoral condyles (Hoffa fractures) are lacking. The aim of this study was to compare the biomechanical properties of anteroposterior (AP) and crossed posteroanterior (PA) screw fixations across differently sized Hoffa fractures on human cadaveric femora. 4 different sizes of lateral Hoffa fractures (n = 12 x 4) were created in 48 distal human femora according to the Letenneur classification: (i) type I, (ii) type IIa, (ii) type IIb, and (iv) type IIc. Based on bone mineral density (BMD), specimens were assigned to the 4 fracture clusters and each cluster was further assigned to fixation with either AP (n = 6) or crossed PA screws (n = 6) to ensure homogeneity of BMD values and comparability between the different test conditions. All specimens were biomechanically tested under progressively increasing cyclic loading until failure, capturing the interfragmentary movements via motion tracking. For Letenneur type I fractures, kilocycles to failure (mean difference [∆] 2.1, 95% confidence interval [CI] -1.3 to 5.5), failure load (∆ 105 N, CI -83 to 293), axial displacement (∆ 0.3 mm, CI -0.8 to 1.3), and fragment rotation (∆ 0.5°, CI -3.2 to 2.1) over 5.0 kilocycles did not differ significantly between the 2 screw trajectories. For each separate subtype of Letenneur type II fractures, fixation with crossed PA screws resulted in significantly higher kilocycles to failure (∆ 6.7, CI 3.3-10.1 to ∆ 8.9, CI 5.5-12.3) and failure load (∆ 275 N, CI 87-463 to ∆ 438, CI 250-626), as well as, less axial displacement from 3.0 kilocycles onwards (∆ 0.4°, CI 0.03-0.7 to ∆ 0.5°, CI 0.01-0.9) compared with AP screw fixation. Irrespective of the size of Letenneur type II fractures, crossed PA screw fixation provided greater biomechanical stability than AP-configured screws, whereas both screw fixation techniques demonstrated comparable biomechanical competence for Letenneur type I fractures. Fragment-size-dependent treatment strategies might be helpful to determine not only the screw configuration but also the surgical approach.

Survival analysis of teeth following clinical crown lengthening and crown insertion procedures up to 14 years: A retrospective cohort study.

The purpose of this study was to conduct survival analysis of teeth following clinical crown lengthening procedures (CLPs) and crown insertions via a retrospective cohort study. Patient- and tooth-related data were collected from 268 participants who received CLPs from 2009 to 2015. The Kaplan-Meier curve and the log-rank tests were used to estimate the probability of survival and compare the survival probabilities among different variables. A Cox multivariate proportional hazard regression model was used to investigate the collective effects of root canal treatment (RCT) and the types of opposing dentition. The rate of tooth loss was 21.6% during the observation period from 1 to 14 years, with 58 teeth extracted. The most attributable reason for tooth extraction was coronal tooth fracture, followed by endodontic failure such as root fracture. The survival probability was 0.87 at 5 years and 0.7 at 10 years. No significant differences in the survival probabilities were found among different providers and locations, the presence of a post, and the types of crowns. The hazard ratio for tooth loss was 6.3, 95% confidence interval (CI) [2.6 to 20.9] in the teeth with RCT (p<0.001) and 2.4, 95% CI [1.1 to 4.8] in the teeth occluding implant-retained prostheses (p=0.016). Tooth loss following CLPs and crown insertions appeared least among the teeth without RCT when occluding natural teeth, while tooth loss was most among the teeth with RCT when occluding implants.

Optimal screw orientation for fixation of coronal shear fractures: a biomechanical comparison

Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum. In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3×3.0mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3×3.0mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2×3.0mm HCCSs in PA orientation and 1×3.0mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens. There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8±0.5mm vs. 0.8±0.6mm; P=.987) or PA and LAT groups (0.8±0.6mm vs. 0.8±0.3mm; P=.966). LAT group showed the highest load-to-failure (548±250N) without reaching statistically significant difference to AP group (388±173N; P=.101). There was also no significant difference between AP and PA groups (388±173N vs. 422±114N; P=.649). Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes-both the coronal and the sagittal plane-by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.

Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures.

Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.

Clinical Outcomes and Management Strategies for Capitellum and Trochlea Fractures: A Systematic Review.

Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures. A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled. Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%). The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.

Outcome of Complex Coronal Shear Fractures of the Distal Humerus (Dubberley Type 3) Managed by the Transolecranon Approach.

Complex distal humerus coronal shear fractures are rare injuries. These fractures involve small articular fragments and are challenging to fix. Aprospective case series of 10 patients was done at a level 1 trauma centre between February 2017 and July 2021. Dubberley type 3 fractures were included in the study. All patients underwent ORIF using posterior approach with olecranon osteotomy by a single surgeon.Patients were followed up for a minimum of 12months postoperatively. The primary outcome measures were radiographic union and functional status of the limb (DASH score and MEPI score). All patients achieved radiographic union of fracture as well as the osteotomy. The mean DASH score as measured on the final follow-up was 12.6 ± 10.2 and the mean MEPI score was 90 ± 8.2. None of the cases needed reoperation. Consistently good functional outcomes can be obtained in complex coronal shear fractures by posterior approach with olecranon osteotomy. Dubberley type 3b patients should undergo additional plate fixation.

Digital smart internal fixation surgery for coronal process basal fracture with normal joint spaces or radius-shortening: Occult factor of radius-ulna load sharing

BackgroundReasonable postoperative humeroradial and humeroulnar joint spaces maybe an important indicator in biomechanical stability of smart internal fixation surgery for coronoid process basal fractures (CPBF). The aim of this study is to compare elbow articular stresses and elbow-forearm stability under smart internal fixations for the CPBF between normal elbow joint spaces and radius-shortening, and to determine the occult factor of radius-ulna load sharing. MethodsCT images of 70 volunteers with intact elbow joints were retrospectively collected for accurate three-dimensional reconstruction to measure the longitudinal and transverse joint spaces. Two groups of ten finite element (FE) models were established prospectively between normal joint space and radius-shortening with 2.0 mm, including intact elbow joint and forearm, elbow-forearm with CPBF trauma, anterior or posterior double screws-cancellous bone fixation, mini-plate-cancellous bone fixation. Three sets of physiological loads (compression, valgus, varus) were used for FE intelligent calculation, FE model verification, and biomechanical and motion analysis. ResultsThe stress distribution between coronoid process and radial head, compression displacements and valgus angles of elbow-forearm in the three smart fixation models of the normal joint spaces were close to those of corresponding intact elbow model, but were significantly different from those of preoperative CPBF models and fixed radius-shortening models. The maximum stresses of three smart fixation instrument models of normal joint spaces were significantly smaller than those of the corresponding fixed radius-shortening models. ConclusionsOn the basis of the existing trauma of the elbow-forearm system in clinical practice, which is a dominant factor affecting radius-ulna load sharing, the elbow joint longitudinal space has been found to be the occult factor affecting radius-ulna load sharing. The stability and load sharing of radius and ulna after three kinds of smart fixations of the CPBF is not only related to the anatomical and biomechanical stability principles of smart internal fixations, but also closely related to postoperative elbow joint longitudinal space.