Varus Posteromedial Rotatory Instability of the Elbow: Injury Pattern and Surgical Experience of 27 Acute Consecutive Surgical Patients

Journal of Orthopaedic Trauma - Tập 32 Số 12 - Trang e469-e474 - 2018
James M. McLean1,2,3, Michael P. Kempston1,2,3, Jeffrey Pike1,2,3, Thomas Goetz1,2,3, Parham Daneshvar1,2,3
1Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
2Institutional review was granted by UBC-PHC Research Ethics Board. The study number is H17-00076.
3Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Tóm tắt

Objectives: To identify associated injuries that occur in varus posteromedial rotatory instability (VPMRI) of the elbow and present their surgical management. Design: Level II retrospective study. Setting: Tertiary referral center. Patient/Participants: Twenty-seven patients with VPMRI injuries treated surgically over an 8-year period. Intervention: Open reduction and internal fixation of anteromedial coronoid facet fracture, lateral collateral ligament repair, and associated injured soft-tissue repairs. Main Outcome Measured: Radiographic classification, associated medial and lateral bony and soft-tissue injuries, surgical fixation method, and complications were recorded. Results: According to the O'Driscoll classification, there were 15 (55%) type 2-2, 11 (41%) type 2-3, and 1 (4%) type 3-1 fractures. Lateral and medial collateral ligament tears were found in 100% and 63%, respectively. Common extensor and flexor origin injuries occurred in 19 (70%) and 2 (7%) elbows, respectively. A marginal radial head fracture was found in 1 patient. Most patients were treated with a combination of fixation methods. Complications occurred in 7 (26%) patients. Conclusions: This study documents both associated findings and surgical fixation methods. In all cases, the lateral collateral ligament was disrupted, often in association with an injured common extensor origin. Medial collateral ligament injuries are commonly involved. Radial head fractures are rarely associated. The surgeon should have a high index of suspicion if an isolated coronoid fracture is encountered. Clinical and functional outcome scores are needed in future studies to further inform treatment of VPMRI of the elbow. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Từ khóa


Tài liệu tham khảo

Budoff, 2012, Coronoid fractures, J Hand Surg Am., 37, 2418, 10.1016/j.jhsa.2012.09.002

Chan, 2016, Selected anteromedial coronoid fractures can be treated nonoperatively, J Shoulder Elbow Surg., 25, 1251, 10.1016/j.jse.2016.02.025

Cohen, 1998, Acute elbow dislocation: evaluation and management, J Am Acad Orthop Surg., 6, 15, 10.5435/00124635-199801000-00002

Morrey, 1996, Acute and chronic instability of the elbow, J Am Acad Orthop Surg., 4, 117, 10.5435/00124635-199605000-00001

O’Driscoll, 2003, Difficult elbow fractures: pearls and pitfalls, Instr Course Lect., 52, 113

Doornberg, 2006, Fracture of the anteromedial facet of the coronoid process, J Bone Joint Surg Am., 88, 2216

Lee, 2012, Coronoid plate fixation of type II and III coronoid process fractures: outcome and prognostic factors, Eur J Orthop Surg Traumatol., 22, 213, 10.1007/s00590-011-0825-7

Park, 2015, How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O'Driscoll classification and ligament injury, J Shoulder Elbow Surg., 24, 74, 10.1016/j.jse.2014.07.010

Rhyou, 2014, Strategic approach to O’Driscoll type 2 anteromedial coronoid facet fracture, J Shoulder Elbow Surg., 23, 924, 10.1016/j.jse.2014.02.016

Ring, 2006, Fractures of the coronoid process of the ulna, J Hand Surg Am., 31, 1679, 10.1016/j.jhsa.2006.08.020

Steinmann, 2008, Coronoid process fracture, J Am Acad Orthop Surg., 16, 519, 10.5435/00124635-200808000-00013

Wang, 2013, Anteromedial coronoid facet fractures, Eur J Orthop Surg Traumatol., 23, 251, 10.1007/s00590-012-0990-3

Pollock, 2009, The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics, J Bone Joint Surg Am., 6, 1448, 10.2106/JBJS.H.00222

Moon, 2013, Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up, Arch Orthop Trauma Surg., 133, 1665, 10.1007/s00402-013-1846-y

McKee, 2005, Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique, J Bone Joint Surg Am., 87, 22

Chen, 2016, Surgical outcomes and complications in treatment of terrible triad of the elbow: comparisons of 3 surgical approaches, Med Sci Monit., 22, 4354, 10.12659/MSM.897297

Garrigues, 2011, Fixation of the coronoid process in elbow fracture-dislocations, J Bone Joint Surg Am., 93, 1873, 10.2106/JBJS.I.01673

Thông tin
Thông tin xuất bản

Journal of Orthopaedic Trauma

Tập 32 Số 12

e469-e474

Thông tin tác giả