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Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures

医学 肘部 前臂 外科 固定(群体遗传学) 桡骨头骨折 运动范围 内侧副韧带 韧带 径向压头 外固定 人口 外固定器 环境卫生
作者
Marc D. McKee,Pugh Dm,Wild Lm,Schemitsch Eh,King Gj
出处
期刊:Journal of Bone and Joint Surgery, American Volume [Journal of Bone and Joint Surgery]
卷期号:87 (1): 22-32 被引量:100
标识
DOI:10.2106/jbjs.d.02933
摘要

BACKGROUND: The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at seven to ten days postoperatively and enhance functional outcome. METHODS: We retrospectively reviewed the results of this treatment performed, at two university-affiliated teaching hospitals, in thirty-six consecutive patients (thirty-six elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvanthinged external fixation. Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up. RESULTS: At a mean of thirty-four months postoperatively, the flexion-extension arc of the elbow averaged 112° ± 11° and forearm rotation averaged 136° ± 16°. The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to fifteen excellent results, thirteen good results, seven fair results, and one poor result. Concentric stability was restored to thirty-four elbows. Eight patients had complications requiring a reoperation: two had a synostosis; one, recurrent instability; four, hardware removal and elbow release; and one, a wound infection. CONCLUSIONS: Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries.
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