AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGXiaohua ¹ , CHENWei ² , LIGuoping ¹ , WANGJianji ¹ , ZHAOHaitao ¹ , SHILitao ¹ , CAOXiangyu ¹ ,  ZHANGYingze ²

1. The Second Department of Orthopaedics, the Affiliated Hospital of Chengde Medical College, Chengde Hebei, 067000, P. R. China;
2. Emergency Center of Trauma, the Third Hospital of Hebei Medical University;

Corresponding author：

ZHANGYingze, Email: dryzzhang@126.com

Keywords：

Elbow joint; Ulna coronoid process fracture; Operation approach; Internal fixation

DOI：

10.7507/1002-1892.20160108

Video：

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Objective To investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. Methods 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. Results 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%. Conclusion 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.

Citation： YANGXiaohua, CHENWei, LIGuoping, WANGJianji, ZHAOHaitao, SHILitao, CAOXiangyu, ZHANGYingze. AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 537-540. doi: 10.7507/1002-1892.20160108 Copy

1.	Stans AA, Maritz NG, O'Driscoll SW, et al. Operative treatment of elbow contracture in patients twenty-one years of age or younger. J Bone Joint Surg (Am), 2002, 84-A(3):382-387.
2.	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.
3.	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.
4.	Morrey BF, Chao EY. Functional evaluation of the elbow//Morrey BF.The elbow and its disorders. Philadelphia:WB Saunders, 1985:73-91.
5.	徐群渊, 主译. 格氏解剖学. 39版. 北京:北京大学医学出版社, 2008:957-964.
6.	Xiao-zhong Zhu, Xin Wang, Zhuo Ma. Comment on the anterior approach for coronoid process fracture. Eur J Orthop Surg Traumatol, 2014, 24(1):123-124.
7.	孔祥玉. 局部解剖学. 西安:世界图书出版公司, 2014:152.
8.	Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg (Am), 2006, 31(1):45-52.
9.	Clarke SE, Lee SY, Raphael JR. Coronoid fixation using suture anchors. Hand (N Y), 2009, 4(2):156-160.
10.	Kälicke T, Muhr G, Frangen TM. Dislocation of the elbow with fractures of the coronoid process and radial head. Arch Orthop Trauma Surg, 2007, 127(10):925-931.
11.	Aksu N, Korkmaz MF, Göğűş A, et al. Surgical treatment of elbow dislocations accompanied by coronoid fractures. Acta Orthop Traumatol Turc, 2008, 42(4):258-264.
12.	Ring D, Doornberg JN. Fracture of the anteromedial facet of the coronoid process. Surgical technique. J Bone Joint Surg (Am), 2007, Suppl 2 Pt. 2:267-283.
13.	Selesnick FH, Dolitsky B, Haskell SS. Fracture of the coronoid process requiring open reduction with internal fixation. A case report. J Bone Joint Surg (Am), 1984, 66(8):1304-1306.
14.	Ameur NE, Rebouh M, Oberlin C. Anterior transbrachial approach of the coronoid apophysis. Chir Main, 1999, 18(3):220-225.
15.	Shukla DR, Koehler SM, Guerra SM, et al. A novel approach for coronoid fractures. Tech Hand Up Extrem Surg, 2014, 18(4):189-193.
16.	苏秀云, 唐佩福. 肘关节手术入路的解剖与临床. 中华解剖与临床杂志, 2015, 20(3):276-280.
17.	Han SH, Yoon HK, Rhee SY, et al. Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol, 2013, 23(4):395-405.
18.	左玉明, 王志强, 王月光, 等. 尺骨冠突骨折的治疗. 中华骨科杂志, 2006, 26(6):366-370.
19.	Elkowitz SJ, Polatsch DB, Egol KA, et al. Capitellum fractures:a biomechanical evaluation of three fixation methods. J Orthop Trauma, 2002, 16(7):503-506.

1. Stans AA, Maritz NG, O'Driscoll SW, et al. Operative treatment of elbow contracture in patients twenty-one years of age or younger. J Bone Joint Surg (Am), 2002, 84-A(3):382-387.
2. 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.
3. 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.
4. Morrey BF, Chao EY. Functional evaluation of the elbow//Morrey BF.The elbow and its disorders. Philadelphia:WB Saunders, 1985:73-91.
5. 徐群渊, 主译. 格氏解剖学. 39版. 北京:北京大学医学出版社, 2008:957-964.
6. Xiao-zhong Zhu, Xin Wang, Zhuo Ma. Comment on the anterior approach for coronoid process fracture. Eur J Orthop Surg Traumatol, 2014, 24(1):123-124.
7. 孔祥玉. 局部解剖学. 西安:世界图书出版公司, 2014:152.
8. Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg (Am), 2006, 31(1):45-52.
9. Clarke SE, Lee SY, Raphael JR. Coronoid fixation using suture anchors. Hand (N Y), 2009, 4(2):156-160.
10. Kälicke T, Muhr G, Frangen TM. Dislocation of the elbow with fractures of the coronoid process and radial head. Arch Orthop Trauma Surg, 2007, 127(10):925-931.
11. Aksu N, Korkmaz MF, Göğűş A, et al. Surgical treatment of elbow dislocations accompanied by coronoid fractures. Acta Orthop Traumatol Turc, 2008, 42(4):258-264.
12. Ring D, Doornberg JN. Fracture of the anteromedial facet of the coronoid process. Surgical technique. J Bone Joint Surg (Am), 2007, Suppl 2 Pt. 2:267-283.
13. Selesnick FH, Dolitsky B, Haskell SS. Fracture of the coronoid process requiring open reduction with internal fixation. A case report. J Bone Joint Surg (Am), 1984, 66(8):1304-1306.
14. Ameur NE, Rebouh M, Oberlin C. Anterior transbrachial approach of the coronoid apophysis. Chir Main, 1999, 18(3):220-225.
15. Shukla DR, Koehler SM, Guerra SM, et al. A novel approach for coronoid fractures. Tech Hand Up Extrem Surg, 2014, 18(4):189-193.
16. 苏秀云, 唐佩福. 肘关节手术入路的解剖与临床. 中华解剖与临床杂志, 2015, 20(3):276-280.
17. Han SH, Yoon HK, Rhee SY, et al. Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol, 2013, 23(4):395-405.
18. 左玉明, 王志强, 王月光, 等. 尺骨冠突骨折的治疗. 中华骨科杂志, 2006, 26(6):366-370.
19. Elkowitz SJ, Polatsch DB, Egol KA, et al. Capitellum fractures:a biomechanical evaluation of three fixation methods. J Orthop Trauma, 2002, 16(7):503-506.

Chinese Journal of Reparative and Reconstructive Surgery

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

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