Effectiveness of improved elbow anteromedial approach in treatment of ulna coronoid process fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Dongsong ¹ , CHEN Hongfeng ¹ , GUO Qianjin ¹ , ZHEN Xiangzhou ¹ ,  LIU Lidi ²

1. Department of Orthopedics, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P.R.China;
2. Department of Orthopedics, the First Hospital of Jilin University, Changchun Jilin, 130021, P.R.China;

Corresponding?author：

LIU Lidi, Email: lld@jlu.edu.cn

Keywords：

Ulna coronoid process fracture; elbow; anteromedial approach; pronator teres muscle

DOI：

10.7507/1002-1892.201701091

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To observe the effectiveness of reduction and fixation by the improved elbow anteromedial approach in treatment of ulna coronoid process fracture. Methods 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. Results 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%. Conclusion 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.

Citation： YANG Dongsong, CHEN Hongfeng, GUO Qianjin, ZHEN Xiangzhou, LIU Lidi. Effectiveness of improved elbow anteromedial approach in treatment of ulna coronoid process fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(12): 1409-1413. doi: 10.7507/1002-1892.201701091 Copy

1.	Hotchkiss RN, Kasparyan GN. The Medial " Over the Top” Approach to the Elbow. Techniques in Orthopaedics, 2000, 15(2): 105-112.
2.	Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital. Injury, 2014, 45(6): 942-948.
3.	張弛, 仲飆, 羅從風, 等. 外側入路聯合前內側入路治療肘關節" 恐怖三聯征”的手術療效. 中華骨科雜志, 2015, 35(4): 320-327.
4.	Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
5.	O’Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
6.	Reichel LM, Milam GS, Reitman CA. Anterior approach for operative fixation of coronoid fractures in complex elbow instability. Tech Hand Up Extrem Surg, 2012, 16(2): 98-104.
7.	Adams JE, Sanchez-Sotelo J, Kallina CF, et al. Fractures of the coronoid: morphology based upon computer tomography scanning. J Shoulder Elbow Surg, 2012, 21(6): 782-788.
8.	楊勇, 王福川. 鉸鏈式外固定架聯合微型鋼板治療肘關節恐怖三聯征. 中國修復重建外科雜志, 2013, 27(2): 151-154.
9.	徐建, 孫晟軒, 李成, 等. 經肘關節前側入路治療尺骨冠狀突前內側面骨折療效觀察. 中國修復重建外科雜志, 2014, 28(7): 806-809.
10.	印飛, 孫振中, 宋升, 等. 肘前方入路治療 MasonⅡ型橈骨小頭骨折合并 Regan-MorreyⅡ型尺骨冠狀突骨折. 中國修復重建外科雜志, 2015, 29(6): 783-784.
11.	楊小華, 陳偉, 李國平, 等. 肘前側神經血管間隙入路治療尺骨冠狀突骨折.中國修復重建外科雜志, 2016, 30(5): 537-540.
12.	朱刃, 周均明, 趙興, 等. 改良肘關節前側入路治療尺骨冠狀突骨折. 中華創傷雜志, 2015, 31(5): 431-434.
13.	姚雙權, 趙昌平, 吳昊天, 等. 肘關節前側入路框架鋼板內固定治療尺骨冠狀突骨折. 中華醫學雜志, 2015, 95(45): 3678-3680.
14.	Sukegawa K, Suzuki T, Ogawa Y, et al. Anatomic cadaveric study of the extensile extensor digitorum communis splitting approach for exposing the ulnar coronoid process. J Shoulder Elbow Surg, 2016, 25 (8): 1268-1273.
15.	陳紅衛, 李軍, 王子陽, 等. 前內側入路治療尺骨冠狀突骨折. 中華手外科雜志, 2015, 31(4): 276-279.
16.	Yan H, He J, Chen S, et al. Intrawound application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows: a retrospective comparative study. J Shoulder Elbow Surg, 2014, 23(5): 686-692.
17.	蔡江瑜, 劉家志, 范存義. 肘關節開放松解聯合內固定取出術治療創傷后肘關節僵硬. 中國修復重建外科雜志, 2016, 29(7): 826-830.
18.	吳關, 魯誼. 肘關節僵硬的治療進展. 中華肩肘外科電子雜志, 2014, 2(2): 123-127.

1. Hotchkiss RN, Kasparyan GN. The Medial " Over the Top” Approach to the Elbow. Techniques in Orthopaedics, 2000, 15(2): 105-112.
2. Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital. Injury, 2014, 45(6): 942-948.
3. 張弛, 仲飆, 羅從風, 等. 外側入路聯合前內側入路治療肘關節" 恐怖三聯征”的手術療效. 中華骨科雜志, 2015, 35(4): 320-327.
4. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
5. O’Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
6. Reichel LM, Milam GS, Reitman CA. Anterior approach for operative fixation of coronoid fractures in complex elbow instability. Tech Hand Up Extrem Surg, 2012, 16(2): 98-104.
7. Adams JE, Sanchez-Sotelo J, Kallina CF, et al. Fractures of the coronoid: morphology based upon computer tomography scanning. J Shoulder Elbow Surg, 2012, 21(6): 782-788.
8. 楊勇, 王福川. 鉸鏈式外固定架聯合微型鋼板治療肘關節恐怖三聯征. 中國修復重建外科雜志, 2013, 27(2): 151-154.
9. 徐建, 孫晟軒, 李成, 等. 經肘關節前側入路治療尺骨冠狀突前內側面骨折療效觀察. 中國修復重建外科雜志, 2014, 28(7): 806-809.
10. 印飛, 孫振中, 宋升, 等. 肘前方入路治療 MasonⅡ型橈骨小頭骨折合并 Regan-MorreyⅡ型尺骨冠狀突骨折. 中國修復重建外科雜志, 2015, 29(6): 783-784.
11. 楊小華, 陳偉, 李國平, 等. 肘前側神經血管間隙入路治療尺骨冠狀突骨折.中國修復重建外科雜志, 2016, 30(5): 537-540.
12. 朱刃, 周均明, 趙興, 等. 改良肘關節前側入路治療尺骨冠狀突骨折. 中華創傷雜志, 2015, 31(5): 431-434.
13. 姚雙權, 趙昌平, 吳昊天, 等. 肘關節前側入路框架鋼板內固定治療尺骨冠狀突骨折. 中華醫學雜志, 2015, 95(45): 3678-3680.
14. Sukegawa K, Suzuki T, Ogawa Y, et al. Anatomic cadaveric study of the extensile extensor digitorum communis splitting approach for exposing the ulnar coronoid process. J Shoulder Elbow Surg, 2016, 25 (8): 1268-1273.
15. 陳紅衛, 李軍, 王子陽, 等. 前內側入路治療尺骨冠狀突骨折. 中華手外科雜志, 2015, 31(4): 276-279.
16. Yan H, He J, Chen S, et al. Intrawound application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows: a retrospective comparative study. J Shoulder Elbow Surg, 2014, 23(5): 686-692.
17. 蔡江瑜, 劉家志, 范存義. 肘關節開放松解聯合內固定取出術治療創傷后肘關節僵硬. 中國修復重建外科雜志, 2016, 29(7): 826-830.
18. 吳關, 魯誼. 肘關節僵硬的治療進展. 中華肩肘外科電子雜志, 2014, 2(2): 123-127.

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

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