Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus / 中国骨伤

OBJECTIVE@#To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience.@*METHODS@#From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded.@*RESULTS@#All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case.@*CONCLUSION@#Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Ulna osteotomy and joint capsule release and tight for old Monteggia's fracture in children / 中国骨伤

<p><b>OBJECTIVE</b>To explore the experience and effect of surgical treatment in old Monteggia fracture in children.</p><p><b>METHODS</b>From January 2013 to December 2017, 32 cases of old Monteggia's fracture were treated including 18 males and 14 females with an average age of(5.3±1.2) years old ranging from 2 to 9 years old. No symptoms of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the "arched sign", the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation.</p><p><b>RESULTS</b>All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation, 29 patients with elbow joint flexion and extension (130±5)°/0°, forearm pronation and supination 90°/(85±5)°; 2 patients with elbow flexion and extension(119°/8°, 121°/7°), forearm pronation and supination (90°/75°, 85°/60°); 1 patient with elbow flexion and extension 90°/10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case.</p><p><b>CONCLUSIONS</b>Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia's fracture in children.</p>