ABSTRACT
Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.
ABSTRACT
Objective To investigate the clinical effects of headless double-threaded compression screws plus microplate for treatment of capitellar fracture of Ring type Ⅱ.Methods In the period from March 2015 to February 2018,12 capitellar fractures of Ring type Ⅱ were treated at Department of Upper limb Orthopedics,Zhengzhou Orthopaedics Hospital.There were 8 men and 4 women,aged from 25 to 57 years (average,35.4 years).There were 5 left and 7 right fractures.The fractures were exposed and reduced through the posterolateral elbow approach in 6 patients and through the lateral elbow approach in the other 6 ones.Fixation of all the fractures was conducted with headless double-threaded compression screws plus microplate.At the final follow-up,the elbow function was evaluated by the Mayo elbow performance score and the severity of traumatic arthritis by the Broberg & Morrey imaging criteria.Results All the patients were followed up for 9 to 36 months (average,23 months).The fracture healing time ranged from 9 to 12 weeks (average,10.6weeks).The final follow-ups revealed fine stability of the affected elbow joint in all the patients,and no loss of reduction,loosening or breakage of internal fixators or ischemic necrosis in any case.At the final follow-ups,the elbow inflection angles ranged from 90° to 130° (average,114.3°),the elbow extension angles from 0° to 20°(average,12.4°),the forearm pronation angles from 50° to 85° (average,70.5°) and the forearm supination angles from 45° to 80° (average,64.3°).The Mayo elbow performance scores at the final follow-up averaged 93.2points (from 85 to 100 points),yielding 8 excellent and 4 good cases.According to the Broberg & Morrey imaging criteria,10 patients showed no regressive change and 2 patients change by one grade.Conclusions A proper surgical approach should be chosen according to the preoperative imaging findings.The fracture of articular surface can be firmly fixated by head-less double-threaded compression screws and the integrity of the distal lateral column of the humerus can be restored with a microplate to achieve a strong biomechanical fixation.Fine clinical outcomes can be obtained by early functional exercise.