Morrey Classification Research Articles

Radiographic Arthrosis After Elbow Trauma: Interobserver Reliability

This study measured observer variation in radiographic rating of elbow arthrosis. Thirty-seven independent orthopedic surgeons graded the extent of elbow arthrosis in 20 consecutive sets of plain radiographs, according to the Broberg and Morrey rating system (grade 0, normal joint; grade 1, slight joint-space narrowing with minimum osteophyte formation; grade 2, moderate joint-space narrowing with moderate osteophyte formation; and grade 3, severe degenerative change with gross destruction of the joint). The kappa multirater measure (κ) was used to estimate reliability between observers, with 0 indicating no agreement above chance, and 1 indicating perfect agreement. There was fair agreement in arthrosis ratings between surgeons. Surgeons with more than 10 years of experience had greater agreement than did surgeons with less experience, and surgeons who treated more than 10 elbow fractures per year had better agreement than did those treating fewer fractures. In post hoc analyses, 2 simplified binary rating systems (eg, "none or mild" vs "moderate or severe" arthrosis) resulted in moderate agreement among observers. The 4 grades of the Broberg and Morrey classification system have only fair interobserver reliability that is influenced by subspecialty and experience. Binary rating systems might be more reliable. Diagnostic III.

Reconstruction of radial capitellar fractures using fine-threaded implants (FFS)

Fractures of the capitulum humeri are rare and challenging injuries to the elbow and outcome results are limited to case series, often with different fixation devices. This article aims to present 15 patients with a fracture of the capitulum humeri treated with the same implant, fine-threaded Kirschner wires (FFS). Besides range of motion and grip strength, outcome measurements include the following scores: the Mayo Elbow Performance index (MEPI); the American Shoulder and Elbow Surgeons’ Elbow Assessment (ASES) Form; the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; and the Broberg–Morrey score. Using the modified Bryan and Morrey classification, there were seven type-I injuries, three type-II, two type-III and three type-IV fractures. In addition to fractures of the capitellum, five patients were diagnosed with a complex ligamentous injury and three had suffered radial head fractures. After a minimum follow-up of 12 months, we obtained a range of motion in flexion and extension of 124° and a pro- and supination of 173°. The mean DASH showed 10.84 and the Broberg–Morrey score reached 90.8. ASES and MEPI scores were 91.5 and 90, respectively. The mean grip strength of the injured side was 217.9 N versus 236.4 N on the healthy side. The use of FFS for capitellar fractures of the humerus achieved good clinical results and these implants can be considered as a treatment option for this fracture entity.

Posterolateral elbow dislocation with sub flexor displacement of radial head fragment

Elbow joints are the second most common joints to dislocate, second only to shoulder joints with most of the dislocations occurring in the posterolateral direction. The dislocations can be simple involving capsuloligamentous structures around the joint or complex involving associated bony injuries. The dislocations can be disabling for the patients with the sequelae involving decreased range of movement, valgus instability due to ruptured medial collateral ligament complex, ectopic calcification, degenerative changes and neurologic deficits. The terrible triad is a type of complex elbow dislocation involving fracture of radial head along with coronoid process fracture. This injury is highly unstable and most of the time requires surgical intervention. We present 2 cases of terrible triad injuries that needed surgical intervention. The radial head fractures in both the cases could be classified as Mason type 2 injuries and the coronoid fractures could be classified as type 1 fracture according to Regan and Morrey classification. The aim of this report is to highlight the medial and distal migration of the fractured fragment of the radial head to the anterior aspect of ulna underneath flexor digitorum profundus, at the junction of proximal third and distal two thirds of the shaft of ulna. On radiographs, this could be mistaken for fractured fragment of coronoid process of ulna, which could mislead the surgeon pre and intra operatively causing delay and confusion in the surgery.

The functional outcome after surgical treatment of capitellar fractures: A retrospective review of sixteen cases

Objectve The purpose of the study was to evaluate the surgical treatment method and outcomes of capitellar fractures. Methods From December 2004 to December 2006, sixteen patients with a capitellar fracture were included in the study. There were eight males and eight females. According to Bryan and Morrey classification, there were eight type Ⅰ fractures, one type Ⅲ fracture and seven type Ⅳ fractures. In three of type Ⅳ, a separate trochlear fracture fragment with impaction was seen. Distal lateral column posteroinferior metaphyseal comminutiou and/or impaction was observed in association with three fractures including two type Ⅳ fractures and one type Ⅲ fracture. One Mason type Ⅰ radial head fracture occurred in association with an ipsilateral type Ⅳ capiteilum fracture. The patients ranged from sixteen to sixty-five years old, with an average age of 44.9 years. An extensile lateral exposure and articular fixation with cannu-lated compression screws were performed within five days of injury. Clinical, radiographic, and functional el-bow index rating scale of Broberg-Money were evaluated retrospectively. Results The follow-up time ranged from 24 to 36 months,with the mean of 29 months. All fractures healed at an average of 7.9 (range, 6 to 11) weeks without radiographic evidence of osteonecrosis of the fracture fragment. Average arc of motion was 125.8°±16.8° in flexion-extension and 163.1°±10.62° in pronation-supination. The mean Broberg-Mor-rey was 92.0 points, with eight excellent results, seven good results, and one poor result. There were one pa-tient with a minimum of grade 1 radio-capitellar arthrosis.Fifteen of the sixteen adults were able to continue their former professional activities. The patient had persistent postoperative stiffness with a flexion contrac-ture at the last postoperative visit. Conclusion Prompt treatment with anatomic reduction and internal fixa-tion with lag screws followed by early rehabilitation can lead to functional arc and satisfactory outcome. Key words: Humeral fractures; Fracture fixation,internal; Treatment outcome

Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws

Fourteen patients with displaced fractures of the humeral capitellum were treated by open reduction and internal fixation of the capitellar fragments with Herbert screws. As per Bryan and Morrey classification, there were seven type I fractures, one type II fracture, three type III fractures, and three non-unions. Patient outcomes were evaluated using the Mayo elbow performance score. The follow-up period ranged from three to seven years (mean 4.8 years). All patients had a stable, pain-free elbow with good range of motion at follow-up. There was no evidence of avascular necrosis or degenerative change.

Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws

The outcome of operatively treated capitellar fractures has not been reported frequently. The purpose of the present study was to evaluate the clinical, radiographic, and functional outcomes following open reduction and internal fixation of capitellar fractures that were treated with a uniform surgical approach in order to further define the impact on the outcome of fracture type and concomitant lateral column osseous and/or ligamentous injuries. A retrospective evaluation of the upper extremity database at our institution identified sixteen skeletally mature patients (mean age, 40 +/- 17 years) with a closed capitellar fracture. In all cases, an extensile lateral exposure and articular fixation with buried cannulated variable-pitch headless compression screws was performed at a mean of ten days after the injury. Clinical, radiographic, and elbow-specific outcomes, including the Mayo Elbow Performance Index, were evaluated at a mean of 27 +/- 19 months postoperatively. Six Type-I, two Type-III, and eight Type-IV fractures were identified with use of the Bryan and Morrey classification system. Four of five ipsilateral radial head fractures occurred in association with a Type-IV fracture. The lateral collateral ligament was intact in fifteen of the sixteen elbows. Metaphyseal comminution was observed in association with five fractures (including four Type-IV fractures and one Type-III fracture). Supplemental mini-fragment screws were used for four of eight Type-IV fractures and one of two Type-III fractures. All fractures healed, and no elbow had instability or weakness. Overall, the mean ulnohumeral motion was 123 degrees (range, 70 degrees to 150 degrees ). Fourteen of the sixteen patients achieved a functional arc of elbow motion, and all patients had full forearm rotation. The mean Mayo Elbow Performance Index score was 92 +/- 10 points, with nine excellent results, six good results, and one fair result. Patients with a Type-IV fracture had a greater magnitude of flexion contracture (p = 0.04), reduced terminal flexion (p = 0.02), and a reduced net ulnohumeral arc (p = 0.01). An ipsilateral radial head fracture did not appear to affect ulnohumeral motion or the functional outcome. Despite the presence of greater flexion contractures at the time of follow-up in elbows with Type-IV fractures or fractures with an ipsilateral radial head fracture, good to excellent outcomes with functional ulnohumeral motion can be achieved following internal fixation of these complex fractures. Type-IV injuries may be more common than previously thought; such fractures often are associated with metaphyseal comminution or a radial head fracture and may require supplemental fixation.

Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws

The outcome of operatively treated capitellar fractures has not been reported frequently. The purpose of the present study was to evaluate the clinical, radiographic, and functional outcomes following open reduction and internal fixation of capitellar fractures that were treated with a uniform surgical approach in order to further define the impact on the outcome of fracture type and concomitant lateral column osseous and/or ligamentous injuries. A retrospective evaluation of the upper extremity database at our institution identified sixteen skeletally mature patients (mean age, 40 +/- 17 years) with a closed capitellar fracture. In all cases, an extensile lateral exposure and articular fixation with buried cannulated variable-pitch headless compression screws was performed at a mean of ten days after the injury. Clinical, radiographic, and elbow-specific outcomes, including the Mayo Elbow Performance Index, were evaluated at a mean of 27 +/- 19 months postoperatively. Six Type-I, two Type-III, and eight Type-IV fractures were identified with use of the Bryan and Morrey classification system. Four of five ipsilateral radial head fractures occurred in association with a Type-IV fracture. The lateral collateral ligament was intact in fifteen of the sixteen elbows. Metaphyseal comminution was observed in association with five fractures (including four Type-IV fractures and one Type-III fracture). Supplemental mini-fragment screws were used for four of eight Type-IV fractures and one of two Type-III fractures. All fractures healed, and no elbow had instability or weakness. Overall, the mean ulnohumeral motion was 123 degrees (range, 70 degrees to 150 degrees). Fourteen of the sixteen patients achieved a functional arc of elbow motion, and all patients had full forearm rotation. The mean Mayo Elbow Performance Index score was 92 +/- 10 points, with nine excellent results, six good results, and one fair result. Patients with a Type-IV fracture had a greater magnitude of flexion contracture (p = 0.04), reduced terminal flexion (p = 0.02), and a reduced net ulnohumeral arc (p = 0.01). An ipsilateral radial head fracture did not appear to affect ulnohumeral motion or the functional outcome. Despite the presence of greater flexion contractures at the time of follow-up in elbows with Type-IV fractures or fractures with an ipsilateral radial head fracture, good to excellent outcomes with functional ulnohumeral motion can be achieved following internal fixation of these complex fractures. Type-IV injuries may be more common than previously thought; such fractures often are associated with metaphyseal comminution or a radial head fracture and may require supplemental fixation.

성인 주관절의 요골두와 구상돌기 골절을 동반한 탈구의 수술 적 치료 (성인 주관절에 발생한 위험3증주의 수술적 치료)

Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture, and further flection, . Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.

とう骨頭骨折の治療成績

We examined surgical treatments and clinical results for fracture of the radial head. The subject consisted of 9 men and 4 women with an average age of 32 years who were followed-up for 6 months to 6 years (mean: 1 year). These B fractures were treated by open reduction and internal fixation with Kirschner wire, mini fragment screw, and mini Herbert screw. We classified them according to the Morrey classification system and used the criteria for the assesment of clinical results described by Wheelers. Five cases were excellent, 5 cases were good, 2 were fair, and 1 was poor. Bone union was achieved in all cases.

Fractures of the coronoid process

A retrospective study has been made of a series of 22 cases, and the classification and treatment of fractures of the coronoid process of the ulna have been discussed. A report has been made of 22 cases of coronoid process fracture (18 males and four females). The mean age was 26 years (range: 19-47 years). According to the Reagan and Morrey Classification, there were 11 type I (avulsion of the tip of the bone), seven type II (a fragment of less than 50% that was detatched from the coronoid process), and four type III cases (a fragment of more than 50% that was detatched from the coronoid process). Elbow dislocation was present in 16 cases, and a radial head fracture was associated in four cases. All type I fractures were treated by immobilization of the elbow in a plaster cast for ten to 15 days, with eight excellent and three good results. In type II fractures, open reduction, internal fixation with antero-posterior lag-screw and early post-operative movement in three patients gave better results than immobilization for three weeks, which was the procedure used in four cases (after transosseous reinsertion in one case). In type III fractures, good results were obtained following open reduction and internal fixation with antero-posterior lag-screw in three patients. The result was average in the fourth case, with immobilization for four weeks. The Reagan and Morrey classification is most useful for the classification of coronoid process fractures. If there is no comminution of the detatched fragment, open reduction and internal fixation with antero-posterior lag-screw is the treatment of choice in type I and II fractures. In type I fractures, immobilization for about two weeks gives good results.