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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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.	张弛, 仲飙, 罗从风, 等. 外侧入路联合前内侧入路治疗肘关节" 恐怖三联征”的手术疗效. 中华骨科杂志, 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.	杨勇, 王福川. 铰链式外固定架联合微型钢板治疗肘关节恐怖三联征. 中国修复重建外科杂志, 2013, 27(2): 151-154.
9.	徐建, 孙晟轩, 李成, 等. 经肘关节前侧入路治疗尺骨冠状突前内侧面骨折疗效观察. 中国修复重建外科杂志, 2014, 28(7): 806-809.
10.	印飞, 孙振中, 宋升, 等. 肘前方入路治疗 MasonⅡ型桡骨小头骨折合并 Regan-MorreyⅡ型尺骨冠状突骨折. 中国修复重建外科杂志, 2015, 29(6): 783-784.
11.	杨小华, 陈伟, 李国平, 等. 肘前侧神经血管间隙入路治疗尺骨冠状突骨折.中国修复重建外科杂志, 2016, 30(5): 537-540.
12.	朱刃, 周均明, 赵兴, 等. 改良肘关节前侧入路治疗尺骨冠状突骨折. 中华创伤杂志, 2015, 31(5): 431-434.
13.	姚双权, 赵昌平, 吴昊天, 等. 肘关节前侧入路框架钢板内固定治疗尺骨冠状突骨折. 中华医学杂志, 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.	陈红卫, 李军, 王子阳, 等. 前内侧入路治疗尺骨冠状突骨折. 中华手外科杂志, 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, 刘家志, 范存义. 肘关节开放松解联合内固定取出术治疗创伤后肘关节僵硬. 中国修复重建外科杂志, 2016, 29(7): 826-830.
18.	吴关, 鲁谊. 肘关节僵硬的治疗进展. 中华肩肘外科电子杂志, 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. 张弛, 仲飙, 罗从风, 等. 外侧入路联合前内侧入路治疗肘关节" 恐怖三联征”的手术疗效. 中华骨科杂志, 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. 杨勇, 王福川. 铰链式外固定架联合微型钢板治疗肘关节恐怖三联征. 中国修复重建外科杂志, 2013, 27(2): 151-154.
9. 徐建, 孙晟轩, 李成, 等. 经肘关节前侧入路治疗尺骨冠状突前内侧面骨折疗效观察. 中国修复重建外科杂志, 2014, 28(7): 806-809.
10. 印飞, 孙振中, 宋升, 等. 肘前方入路治疗 MasonⅡ型桡骨小头骨折合并 Regan-MorreyⅡ型尺骨冠状突骨折. 中国修复重建外科杂志, 2015, 29(6): 783-784.
11. 杨小华, 陈伟, 李国平, 等. 肘前侧神经血管间隙入路治疗尺骨冠状突骨折.中国修复重建外科杂志, 2016, 30(5): 537-540.
12. 朱刃, 周均明, 赵兴, 等. 改良肘关节前侧入路治疗尺骨冠状突骨折. 中华创伤杂志, 2015, 31(5): 431-434.
13. 姚双权, 赵昌平, 吴昊天, 等. 肘关节前侧入路框架钢板内固定治疗尺骨冠状突骨折. 中华医学杂志, 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. 陈红卫, 李军, 王子阳, 等. 前内侧入路治疗尺骨冠状突骨折. 中华手外科杂志, 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, 刘家志, 范存义. 肘关节开放松解联合内固定取出术治疗创伤后肘关节僵硬. 中国修复重建外科杂志, 2016, 29(7): 826-830.
18. 吴关, 鲁谊. 肘关节僵硬的治疗进展. 中华肩肘外科电子杂志, 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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