Fractures Of Ulnar Coronoid Process Research Articles

Arthroscopic Reduction and Fixation of Coronoid Fractures with Bending K-Wire: A New Technique.

The ulnar coronoid process plays a key role in maintaining elbow stability; however, there is no gold standard treatment for ulnar coronoid process fractures. We present a novel surgical technique, arthroscopic reduction and bent K-wire fixation, for type II and III coronoid process fractures according to the O’Driscoll classification. Five patients were treated and retrospectively reviewed between January 2016 and December 2019. All the surgeries were performed by a single surgeon. We evaluated clinical outcomes by evaluating a range of motion, disability of arm, shoulder, and hand (DASH) score, Mayo Elbow Performance score (MEPS), and radiographic images. Intraoperative and postoperative radiographs showed that the fractures healed well and were satisfactorily fixed. The average elbow extension/flexion was −3/130, with an average DASH score of 2.42 and MEPS of 97. Coronoid process fractures can be treated successfully with arthroscopic reduction and fixation of bent K-wire, which allows more rigid fixation and early functional exercise, resulting in good outcomes without special tools.

Single Modified Posterior Approach through the Space of the Proximal Radioulnar Joint for Terrible Triad Injury: A Comparative Study.

ObjectiveIn order to reduce surgical scars and the risk of neurovascular injury for the treatment of terrible triad injuries of the elbow (TTI), minimally invasive and better therapeutic effect approaches are being explored to replace the conventional combined lateral and medial approach (CLMA). This study was performed to compare the clinical effect and security of the modified posterior approach (MPA) through the space of the proximal radioulnar joint vs the CLMA for treatment of TTI.MethodsThis study retrospectively analyzed 76 patients treated for TTI from January 2009 to December 2020 (MPA: n = 44; CLMA: n = 32). Treatment involved plate and screw fixation or Steinmann pin fixation for the radial head and ulnar coronoid process fractures. Surgeons only sutured the lateral ligament because the medial collateral ligament was usually integrated in the TTI. The continuous variables were compared by the independent Student t‐test and the categorical variables by the χ2‐test or Fisher's exact test.ResultsBoth groups of patients attained a satisfactory MEPS after the operation. The MEPS (MPA: 96.82 ± 6.04 vs CLMA: 96.56 ± 5.51) was not significantly different between the two groups (p > 0.05). However, the MPA resulted in better elbow flexion and extension (MPA: 123.98 ± 10.09 vs CLMA: 117.66 ± 8.29), better forearm rotation function (MPA: 173.41 ± 6.81 vs CLMA: 120.00 ± 12.18), and less intraoperative hemoglobin (MPA: 9.34 ± 5.64 vs CLMA: 16.5 ± 8.75) and red cell volume loss (MPA: 3.09 ± 2.20 vs CLMA: 6.70 ± 2.97) (All p < 0.05). Although the CLMA had a shorter surgery time (MPA: 171.73 ± 80.68 vs CLMA: 130.16 ± 71.50) (p < 0.05), it had a higher risk of neurologic damage (MPA: 0 vs CLMA: 4) (p < 0.05). Four patients developed forearm or hand numbness after the CLMA, but no patients developed numbness after the MPA. All 76 patients were followed up for 15 months postoperatively.ConclusionThe MPA through the space of the proximal radioulnar joint has more prominent advantages than the CLMA for TTI, including single scar, clear exposure, good fixation, lower risk of neurovascular injury, and better elbow joint motion. It is a safe and effective surgical approach that is worthy of clinical promotion.

The Novel Hooked Kirschner Wire Technique for Ulna Coronoid Process Fractures.

The aim of this study was to introduce a novel technique to improve the ease of fixing of even small fragments of the coronoid process and report the clinical outcomes of this method. Forty-nine patients with ulnar coronoid process fractures fixed using the hooked Kirschner wire (K-wire) technique at our hospital from 2007 to 2019 were reviewed. Radiological features and fracture union were assessed using simple radiographs. Functional outcomes of the treated elbows were evaluated at the final follow-up visit using the Mayo Elbow Performance Score (MEPS). All patients were examined at a mean follow-up of 17.7 months (range, 6-62 months). We observed bony union in patients at a mean of 10.9 weeks (range, 6-22 weeks). The mean flexion and extension ranges of the elbow were 132.0° (range, 106° -151°) and 4.5° (range, -20° to 30°), respectively. The mean pronation and supination ranges of the forearm were 81.1° (range, 60°-90°) and 88.3° (range, 60°-120°), respectively. The mean arc of the elbow was 127.4° (range, 78°-160°). All patients were evaluated using the MEPS at the final follow-up visit, with a mean score of 96.9 points (range, 80-100 points). One case of coronoid nonunion was observed and re-fixation was performed. One case of infection was observed and also treated with additional surgery. Three patients complained of ulnar nerve symptoms and 1 patient underwent surgical release for tardy ulnar nerve palsy. Despite its limitations, the hooked K-wire technique was a useful method for even smaller coronoid process fractures. K-wires were also a useful temporary intraoperative fixation method and could provide permanent fixation.

The three-column concept of elbow joint stability and the Wrightington elbow fracture-dislocation classification, emphasizing the role of cross-sectional imaging.

Elbow fracture-dislocation is a complex injury with a combination of osseous and soft tissue disruption. Different classification systems have been used to describe the injury pattern and help guide the management. The article describes the important cross-sectional findings in complex elbow fracture-dislocation injuries based on the relatively new Wrightington classification. This includes the various elements and patterns seen in elbow fracture-dislocations providing a simple and comprehensive system to classify these injuries and help guide the surgical management. The article also describes the three-column concept of elbow joint stability, dividing the elbow joint osseous structures into lateral, middle and medial columns. Detailed radiological assessment of the fractures pattern is vital to understand the mechanism of injury, allowing clinicians to predict the associated capsuloligamentous injury and help guide the management decisions. The Wrightington elbow fracture-dislocation classification categorizes the injuries according to the ulnar coronoid process and radial head fractures. Type A is an anteromedial coronoid fracture. Type B is a bifacet or basal coronoid fracture, with B + indicating associated radial head fracture. Type C is a combined anterolateral facet and radial head or comminuted radial head fractures. Type D is a diaphyseal ulnar fracture, with D + indicating associated radial head fracture.

Clinical observation of double mini locking plate in the treatment of olecranon fracture

To investigate the clinical effect of double mini-locking plates in the treatment of ulna olecranon fractures. From March 2017 to May 2020, 19 patients with olecranon fractures were treated with double mini locking plates, including 12 males and 7 females, aged from 20 to 75 years old with an average of (40.50±7.62) years old;10 patients had the injuries on the left side and 9 patients on the right side. All the 19 patients were fresh closed fractures without ulnar coronoid process fracture, elbow dislocation and other injuries. The fracture healing time and complications were recorded, and the clinical efficacy was evaluated by Mayo elbow performance score (MEPS) before operation and 12 months after operation. All the 19 patientswas followed up, and the duration ranged from 12 to 17 months with an average of (13.51±3.17) months. Postoperative follow-up showed all fractures healed. Fracture healing time ranged from 2 to 6 months, with an average of(3.77±1.24) months. There was no internal fixation fracture, screw loosening, infection, internal fixation irritation, heterotopic ossification, elbow stiffness and other complications occurred. The MEPS score of affected elbow at 12 months after operation was 91.26±3.87, which was significantly different from that before operation 56.18±9.56 (P<0.05);according to Mayo Elbow function score standard, 11 cases were excellent, 7 cases were good, and 1 case was fair. It is a reliable fixation method to treat olecranon fracture with double mini locking plate. The incision lengh is small and the fracture fixation is reliable. Elbow joint function exercise can be performed early after operation. Postoperative internal fixation has less skin irritation and satisfactory elbow joint function recovery.

Abord entre le muscle ronator teres (rond pronateur) et le fléchisseur radial du carpe pour la fixation des fractures du processus coronoïde de l’ulna

BackgroundThe optimal approach for the fixation of coronoid process fractures is unknown. We present the advantages and the clinical effect of the pronator teres and the flexor carpi radialis interval approach for the treatment of ulna coronoid process fractures. MethodsThe patients who had operative treatment of closed ulna coronoid process fracture by the pronator teres and the flexor carpi radialis interval approach between January 2011 to December 2016 were studied retrospectively. Seventeen consecutive patients had received surgical fixation by screws or a mini-plate through the above approach, of whom 16 males and one female with an average age of 36.7 years (range, 21–58 years). There were 11 cases of type II and 6 cases of type III according to the O’Driscoll classification; of whom 6 patients had combined elbow dislocation, 2 patients showed elbow instability after fixation, 1 had another incision to repair the lateral collateral ligament, and received a hinged external fixator. The other patient only received a hinged external fixator for 4 weeks. Mayo Elbow Performance Score (MEPS) was used to assess the function of elbow for each patient at the final follow-up. ResultsMean follow-up was 28.7 months (range, 24–38 months). Fracture union was achieved in each patient; the average time to radiologic union was 14.2 weeks (range, 12–16 weeks). At the final follow-up, the elbow extension degree of the affected side was (3.88±2.96°), reaching 98.1% of the normal side, and the flexion degree was (131.59±4.93°), reaching 98.16% of the normal side. The forearm pronation was (82.94±3.86°), reaching 94.31% of the normal side, and the supination activity was (82.12±3.82°), reaching 93% of the normal side. According to the MEPS, the functional recovery of the injured arm was assessed as excellent in 16 cases, and good in one. None of the patients showed any neurovascular or deep infections and no heterotopic ossification was found. ConclusionsThe pronator teres and the flexor carpi radialis interval approach has the advantages of simplicity, safety, minimal invasion, excellent exposure, and good postoperative function recovery for ulna coronoid process fracture.

尺骨鉤状突起骨折の治療におけるOver-the-Top アプローチの経験

尺骨鉤状突起骨折の治療におけるOver-the-Top アプローチの経験

Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow

To investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow. Retrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score. The operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides ( P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%. For patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness.

Treatment of ulnar coronoid process fracture via a modified anteromedial approach

To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

The pronator teres and the flexor carpi radialis interval approach for operative fixation of ulna coronoid process fractures

BackgroundThe optimal approach for the fixation of coronoid process fractures is unknown. We present the advantages and the clinical effect of the pronator teres and the flexor carpi radialis interval approach for the treatment of ulna coronoid process fractures. MethodsThe patients, who had operative treatment of closed ulna coronoid process fracture by the pronator teres and the flexor carpi radialis interval approach between January 2011 to December 2016, were studied retrospectively. Seventeen consecutive patients had received surgical fixation by screws or a mini-plate through the above approach, of whom were 16 males and one female with an average age of 36.7 years (range, 21–58 years). There were 11 cases of type II and 6 cases of type III according to the O’Driscoll classification, of which, 6 patients had combined elbow dislocation, 2 patients showed elbow instability after fixation, and one had another incision to repair the lateral collateral ligament, and received a hinged external fixator. The other patient only received a hinged external fixator for 4 weeks. Mayo Elbow Performance Score (MEPS) was used to assess the function of elbow for each patient at the final follow-up. ResultsMean follow-up was 28.7 months (range, 24–38 months). Fracture union was achieved in each patient; the average time to radiologic union was 14.2 weeks (range, 12–16 weeks). At the final follow-up, the elbow extension degree of the affected side was (3.88±2.96°), reaching 98.1% of the normal side, and the flexion degree was (131.59±4.93°), reaching 98.16% of the normal side. The forearm pronation was (82.94±3.86°), reaching 94.31% of the normal side, and the supination activity was (82.12±3.82°), reaching 93% of the normal side. According to the MEPS, the functional recovery of the injured arm was assessed as excellent in 16 cases, and good in one. None of the patients showed any neurovascular or deep infections and no heterotopic ossification was found. ConclusionsThe pronator teres and the flexor carpi radialis interval approach has the advantages of simplicity, safety, minimal invasion, excellent exposure, and good postoperative function recovery for ulna coronoid process fracture.

Design of a novel anatomical plate for fractures of ulnar coronoid process

Objective To evaluate a self-designed novel anatomical bone plate for fractures of ulnar coronoid process in cadaveric specimens. Methods Our database search in the Imaging Center, Qilu Hospital of Shandong University (Qingdao) yielded CT reconstruction images of 45 normal adult elbows (26 males and 19 females) which met our criteria. On the 3D reformatted CT images, sagittal curvature angle of the ulnar coronal process (△1), tangent angle of the coronal process apex to olecranon fossa (△2), projective length (L) and projective height (H) were measured; the transverse width of the coronal process was also measured at 5 mm and 10 mm from the tip (K1 and K2). The minimum value was used for △2° in order to avoid cutting into the joint while the mean value for other parameters. After the shape of the plate and angles of the screws were designed using computer 3D software, a new anatomic plate for coronal process was produced. Five cadaver specimens were used to test the internal fixation of the coronal process with our novel anatomic bone plate. Attachment of the bone plate to the coronal process and screw penetration into the joint cavity were observed by X-ray and 3D CT scanning. Results △1 was 45.52°±6.07°, △2 65.25°±7.09° (the minimum value 53.2°), L 52.27±7.78 mm, H 21.62±2.63 mm, K1 16.32±2.22 mm and K2 14.58±2.18 mm. Our new anatomic bone plate was designed based on the above data. X-ray and 3D CT scan after plate internal fixation showed that our self-designed bone plate produced fine attachment and no screws penetrated into the joint. Conclusion Our new anatomical bone plate may perfectly fit the anatomy of the adult ulnar coronal process in size and shape so that the coronary process can be fully covered and no screws will penetrate into the joint cavity. Key words: Bone plate; Elbow Joint; Anatomy; Cadaver

Treatment of ulnar coronoid process fractures through the medial operative approach of double windows in a single incision

Objective To analyze the related anatomical characteristics around ulnar coronoid process, design the medial operative approach of double windows in a single incision to expose ulnar coronoid process, and explore the surgical methods and clinical effects of this approach in the treatment of ulnar coronoid process fractures. Methods Three adult cadaveric specimens (6 sides) were used to perform anatomy research related to ulnar coronoid process of elbow joint. The reasonable methods of exposure and internal fixation of ulnar coronoid process were discussed. We designed the medial operative approach of two windows in a single incision and simulated operation. 11 cases of ulnar coronoid process fractures were treated by open reduction and internal fixation through the approach. After the operation, the adjustable orthosis of elbow joint were used for 4 to 6 weeks. The flexion and extension function of the elbow joint was gradually exercised 1 week after the operation. The elbow joint function was evaluated by MEPS and Broberg-Morrey scoring system at the last follow-up. Results All the patients were follow-up for 12 to 24 months with an average of 15.5 months. All the fractures achieved primary healing without complications of neurovascular injury. No fracture re-displacement and internal fixation failure occurred. The MEPS score of the last follow-up was excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The medial operative approach of double windows in a single incision for the treatment of ulnar coronoid process fractures can provide good exposure, which is conducive to fracture reduction and fixation with satisfactory clinical effects. Key words: Fracture fixation, internal; Treatment outcome; Ulnar coronoid process; Operative approach

Effectiveness of improved elbow anteromedial approach in treatment of ulna coronoid process fracture

To observe the effectiveness of reduction and fixation by the improved elbow anteromedial approach in treatment of ulna coronoid process fracture. Between January 2010 and December 2014, 13 patients with the ulna coronoid process fracture were treated with reduction and fixation by the improved elbow anteromedial approach. There were 10 males and 3 females with an average age of 37.2 years (range, 18-57 years). Five cases were caused by traffic accident, 7 cases by falling injury from height, and 1 case by object impact injury. Seven cases were the terrible triad of the elbow, 4 cases were the ulna coronoid process and radial head fractures, 1 case was the proximal radius and ulna fractures, and 1 case was the ulna coronoid process and distal radius fractures. According to Regan-Morrey classification criteria, the ulna coronoid process fracture was rated as type Ⅱ in 2 cases and as type Ⅲ in 11 cases. According to O'Driscoll classification criteria, 10 of the 13 cases were anterior coronoid fracture (8 cases of type Ⅱb, 2 of type Ⅱc), and 3 of basal fracture. The operation time, amount of intraoperative bleeding, postoperative complications, range of motion (ROM) of the elbow joint, Mayo elbow function index (MEPI) score and fracture healing time were recorded. The average operation time was 38.7 minutes (range, 30-55 minutes), and the average amount of intraoperative bleeding was 109.3 mL (range, 90-160 mL). All incisions healed at stage Ⅰ. There was no iatrogenic vascular or nerve injury. All patients were followed up 13-24 months (mean, 16.9 months). All fractures achieved clinical healing. The average healing time was 11.2 weeks (range, 8-16 weeks). There were 2 cases of heterotopic ossification. At last follow-up, the ROM of elbow flexion was 119-145° (mean, 132.4°); the ROM of elbow extension was -8-15° (mean, 7°). The ROM of forearm pronation was 68-90° (mean, 78.6°), and the ROM of forearm supination was 76-90° (mean, 84.3°). At last follow-up, the MEPI score was 70-100; and 9 cases were excellent, 3 cases were good, and 1 case was fair. The excellent and good rate was 92.3%. Improved elbow anteromedial approach for the ulna coronoid process fracture can not only avoid the injuries of surrounding blood vessels and nerves, but also perform fracture reduction and fixation under direct vision. It is a safe, simple, and effective treatment method for the ulna coronoid process fracture.

Treatment of ulna coronoid process fracture with mini-plate internal fixation through modified anterior approach of elbow joint

Objective To investigate the curative effects of mini-plate internal fixation through modified anterior approach of elbow joint for the treatment of ulna coronoid process fracture. Methods From January 2013 to December 2015, 11 cases of ulna coronoid process fracture were treated by mini-plate internal fixation through modified anterior approach of elbow joint. The functional recovery of elbow joint was evaluated after the operation. Results All the patients were follow-up for 8 to 25 months with an average of 15.4 months. Bone healing was achieved in all the cases showed by X-ray. The range of motion was (115.00±8.56)° for elbow flexion and extension, (130.00±6.58)° for forearm rotation. According to Mayo Elbow Performance Score, the elbow function was rated as excellent in 6 cases, good in 4 cases, fair in 1 case. Mild heterotopic ossification occurred in 1 case. Lateral brachial cutaneous nerve injury occurred in 1 case. No infection, vascular injury, joint dislocation, traumatic arthritis and stiffness occurred. Conclusion In the treatment of ulna coronoid process fracture, elbow joint can be fully exposed by modified anterior approach and mini-plate internal fixation is reliable to achieve good clinical effect. Key words: Elbow joint; Fracture fixation, internal; Surgical approach; Mini plate

Mini-locking plates for the treatment of Regan-Morrey type III fracture of ulnar coronoid process through anterior approach of elbow joint

To explore clinical effects of mini-locking plates for the treatment of Regan-Morrey type III fractures of ulnar coronoid process through an anterior approach of elbow joint. A retrospective analysis on 12 patients with Regan-Morrey type III fractures of the ulnar coronoid process was performed from January 2011 to June 2014, who were treated with unini-locking plates through the anterior approach of elbow joint. There were 7 males and 5 females, ranging in age from 23 to 65 years old, averaged 43 years old. Four patients had fractures on the left and 8 patients had fractures on the right. The X-ray films were taken to evaluate the location and healing of the fracture before and after operation. Clinical evaluation included analysis on surgical complications, range of motion and Mayo elbow function score. All the patients were treated with mini-locking plates, and the elbow joint was stable after operation. All the patients were followed up, and the duration ranged from 14 to 36 months. All the fractures were healed, and the healing time ranged from 12 to 20 weeks. The average healing time was 15.6 weeks. There were no complications occurred such as heterotopic ossification, traumatic arthritis and others. At the latest follow-up, the average angle of elbow flexion was (127.0±5.6)°(120° to 135°); the average extension angle was(4.2±4.5)° (0° to 10°); the average pronation angle of forearm was (86.0±6.1)°(75° to 90°); the average supination angle of forearm was (87.0±6.9)°(80° to 100°). Mayo elbow function score was 80 to 96 points, with an average of 88 points, of which 2 cases got an excellent result, 10 good. Elbow anterior approach can clearly expose the Regan-Morrey type III coronoid fractures, and mini-locking plate fixation has a satisfactory effect.

Mini-plate fixation of ulnar coronoid process fracture via anteromedial approach

Objective To investigate the clinical efficacy of mini-plate fixation for ulnar coronoid process fracture via anteromedial approach. Methods A retrospective review was made on 28 cases of ulnar coronoid process fracture treated with open reduction and mini-plate fixation from April 2010 to December 2014. There were 18 males and 10 females, with age range of 21-60 years(mean, 34.3 years). Causes of injury were falls in 21 cases and traffic accidents in 7 cases. According to the O’Driscoll classification, there were 14 cases of type Ⅰ, 11 cases of type Ⅱ and 3 cases of type Ⅲ. Time from injury to operation was 2-10 d(mean, 3.7 d). Reduction loss, fracture healing time and complications were documented.Elbow function was evaluated at the last follow-up by Mayo elbow performance score(MEPS)and Broberg & Morrey score. Results All cases were followed up for 12-25 months(mean, 15.1 months). Restricted elbow activity was initiated one week after operation. Bone united in mean 10.6 weeks(range, 8-14 weeks). No nerve injury or fracture redisplacement occurred. At the final follow-up, mean flexion was(124±15)°(range, 90°-140°), mean extension loss was(18±20)°(range, 0°- 50°), mean pronation was(65±18)°(range, 40°- 85°), and mean supination was(63±16)°(range, 35°- 85°), showing significant difference in comparison with the preoperative measure(P<0. 05). According to the MEPS, the results were excellent in 17 cases, good in 8, fair in 2 and poor in 1. According to the Broberg & Morrey score, the results were excellent in 16 cases, good in 8, fair in 3 and poor in 1. Conclusion Through anteromedial approach, mini-plate fixation of the ulnar coronoid process fracture provides rigid fixation, which benefits joint stability and bone union, and allows early functional exercise. Key words: Unlar fractures; Fracture fixation, internal; Mini-plate

AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE

To investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. Between February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. All incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. Anterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.

Treatment of fracture of radial head combined with bony instability around the elbow

Objective To investigate the therapeutic strategies of radial head fracture combined with bony instability around the elbow. Methods From January 2003 to June 2011, 31 patients with radial head fracture combined with bony instability around the elbow were treated. They were 21 males and 10 females, from 20 to 65 years of age (average, 42.6 years). Ulnar coronoid process fracture was found in 11 patients, ulnar olecranon fracture in 14 and capitellum fracture in 6. The radial head fracture was Mason type Ⅱ in 13 patients and Mason type Ⅲ in 18. All patients with radial head fracture were treated with mini-plate or screws. The 3 cases of ulnar coronoid process fracture of typeⅠ received conservative treatment when there was no displaced fracture fragment, or surgery after removal of the fragments in the joint and suture of the capsule. The 7 cases of type Ⅱand type Ⅲ fractures received internal fixation with Kirschner wire or micro-plate after the anterior bundle of the ulnar collateral ligaments (UCL) were repaired. Bone and ligament reconstructions were necessary to rebuild elbow stability in one patient with type Ⅳ fracture. For the ulna olecranon fractures, Kirschner wire with tensile band was used in non-comminuted ones, or plate and screw fixation and bone graft in the 6 comminuted ones. The 6 cases of type I capitellum fracture were treated with compression screw fixation. Results All wounds healed at the primary stage. All fractures united after 3 to 6 months (average, 5.1 months). All the patients were followed up for 18 to 36 months (average, 24.3 months). Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification in 4. The mean range of motion (ROM) of the affected elbow joint was 104°, and the ROM of forearm rotation was 118°. According to Broberg & Morrey evaluation system, the elbow function was rated as excellent in 7 patients, good in 15, fair in 6 and poor in 3. The excellent and good rate was 71.0% . Conclusions In order to achieve good functional restoration of the elbow joint, the radial head fractures should be anatomically reduced and internally fixated with mini-plate or screws. Injury to the bony structures around the elbow, such as ulnar coronoid process fracture, ulnar olecranon fracture and capitellum fracture, must be repaired or reconstructed. Key words: Elbow joint; Radius fractures; Joint instability

Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?

The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention. Thirty-nine patients with terrible triad of the elbow characterized by a Mason type-III RH fracture were randomly divided into either an RH repair group (n = 19) or an RH replacement group (n = 20). The complication rates, radiological outcomes, Mayo Elbow Performance Score and range of motion of the elbow were analysed. Follow-up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant (P < 0.001). The outcomes in terms of Mayo Elbow Performance Score (P = 0.009), flexion-extension arc (P = 0.01) and pronation-supination arc (P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post-surgery complications than those in the RH repair group (P = 0.04). Treating Mason type-III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post-surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.

Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation.

In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. In this review, the classification, treatment principles and prognosis for different forms of management of the radial head and ulnar coronoid process fractures and the ligaments lesions are introduced sequentially and various surgical procedures and their efficacy are discussed. This triad has long given orthopedic surgeons headaches. Nonetheless, in recent years a series of anatomical mechanical studies on the elbow joint have been published and there have been several breakthroughs in surgical techniques for managing this elbow triad. This review examines some memorable millstones and unveils trends in the current clinical norm for this triad. The accomplishments achieved recently have reportedly resulted in enhanced prognoses in the last two or three years compared with previous years. It is therefore high time to revise our thoughts about the justice and accuracy of defining this triad of the elbow as terrible. Lastly, we may safely conclude that the terrible triad of the elbow is much less terrible than previously, provided the commonly approved clinical approaches are undertaken.