Olecranon osteotomy vs. triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.@*METHODS@#The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.@*RESULTS@#Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.@*CONCLUSIONS@#This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Is anterior transposition of ulnar nerve beneficial during open reduction and internal fixation for intercondylar humerus fractures / 中国骨伤

OBJECTIVE@#To compare activity, function and postoperative ulnar nerve function of elbow joint by anterior transposition of ulnar nerve or not during open reduction and internal fixation for intercondylar humerus fractures.@*METHODS@#From January 2013 to May 2017, 168 patients with intercondylar humerus fractures were treated surgically with open reduction and internal fixation (ORIF). The patients were divided into anterior subcutaneous transposition group and simple decompression group according to handling method of ulnar nerve. There were 48 patients in transposition group, including 23 males and 25 females with an average age of (42.5±15.7) years old ranging from 14 to 77 years old, and ulnar nerve treated enough free and anterior subcutaneous transpostion after reduction of intercondylar humerus fractures; while there were 120 patients in simple decompression group, including 62 males and 58 females with an average age of (43.4±17.3) years old ranging from 14 to 81 years old, ulnar nerve returned to sulci nervi ulnaris. Activity of flexion and extension of elbow joint, range of rotation of forearm were recorded at the latest following-up, Mayo score of elbow joint was used to evaluate clinical effect, McGowan grading was used to assess dysfunction of unlnar nerve.@*RESULTS@#There was 1 patient delayed union, and 2 patients occurred joint stiffness in transposition group; while 1 patient suffered from incision infection, 1 fracture nonunion, and 4 joint stiffness in simple decompression group; and there was no statistical difference between two groups(>0.05). Forty-eight patients in transposition group were followed-up from 12 to 59 months with an average of (32.2±14.2) months, activity of flexion and extension of elbow joint was (116±28)°, range of rotation of forearm was (152±12)°, MEPS score was 88.6±11.6; and 28 patients got excellent results, 16 good, 3 moderate and 1 poor. There were 17 patients occurred injury of ulnar nerve, and 7 patients still occurred dysfunction of ulnar nerve, and 6 patients were grade I, 1 patient was grade II according to McGowan grading. In simple decompression group, there were 120 patients were followed-up from 13 to 61 months with an average of (32.0±14.9) months, activity of flexion and extension of elbow joint was (119±27)°, range of rotation of forearm was (154±16)°, MEPS score was 88.9±12.5; and 67 patients got excellent results, 44 good, 7 moderate and 2 poor. There were 42 patients occurred injury of ulnar nerve, and 22 patients still occurred dysfunction of ulnar nerve, and 18 patients were grade I, 4 patients were grade II according to McGowan grading. There were no statistical differences in following time, activity of flexion and extension of elbow joint, range of rotation of forearm, MEPS score and dysfunction of ulnar nerve.@*CONCLUSIONS@#Whether anterior transposition of ulnar nerve or not has no clarified effects for open reduction and internal fixation for intercondylar humerus fractures.

Clinical observation of olecranon sled for the treatment for olecranal fracture / 中国骨伤

OBJECTIVE@#To explore clinical effect of olecranon sled in treating olecranal fracture.@*METHODS@#Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function.@*RESULTS@#Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0.@*CONCLUSIONS@#Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.

Clinical outcomes of open reduction and internal fixation in treating Gustilo typeI and II patients with open distal humeral fractures / 中国骨伤

OBJECTIVE@#To analysis clinical effects of open reduction and internal fixation in treating Gustilo type I and II patients with open distal humeral fracture.@*METHODS@#From 2013 May to 2017 June, 24 patient with Gustilo grade I and II open distal humeral fractures were treated with open reduction and internal fixation, including 20 males and 4 females, aged from 14 to 65 years old with an average of (41.3±13.1) years old. According to Gustilo classification, 16 patients were type I, 8 patients were typeII. Range of motion, complications and secondary surgery were recorded; elbow function were evaluated with VAS (visual analogue scale), MEPS (Mayo elbow performance score) and QuickDASH (quick disabilities of the arm, shoulder, and hand) at 12 months after operation.@*RESULTS@#All patients were followed up from 15 to 60 years with an average of (34.1±11.9) months. VAS score was 0(0, 2); flexion and extension ranged from 50 °to 145° with an average of (115.2±26.1)°; the range of rotation ranged from 100° to 160° with an average of (147.7±17.0)°. MEPS score was for 75 to 90 (90.0±9.1), and 14 patients got excellent result, 10 patients moderate. Quick DASH score was 4.6(0, 14.8). There were 22 patients occurred complications, such as ulnar nerve symptom and internal fixation irritation, and 10 patients accepted the second operation.@*CONCLUSIONS@#Open reduction and internal fixation is a safe and efficient method in treating Gustilo type I and II patients with open distal humeral fractures, which has an advantages of good range of movement and function score.

Progress on diagnosis and treatment of low transcondylar fractures of distal humerus / 中国骨伤

Low transcondylar fractures of the distal humerus in adults is rarely seen and reported in literatures. It has a bimodal distribution in terms of age, affecting the elderly and younger patients. The fracture is characterized by a very low transverse intra-capsular and extra-articular fracture lines extending from the level of lateral epicondyle to medial epicondyle. Standard elbow plain films and CT scans are crucial and indispensable for diagnosis. Conservative treatment is suitable for undisplaced fractures, patients who are intolerant of anesthesia, or people with advanced dementia. Open reduction and internal fixation (ORIF) is preferred. Parallel and orthogonal plate fixation are widely adopted while some researchers preferred crisscross-type screw fixation or bicolumnar 90-90 plating. In addition, some customized posterolateral plates are specially designed to be able to insert a transverse screw, functioning as lateral support. However, most of the recent researches conducted on low transcondylar fractures of the distal humerus are retrospective studies with relatively lower level of evidence compared to prospective and randomized controlled ones which remain a vacancy in this field. Therefore, further studies comparing the biomechanical properties and clinical prognosis of different configurations of internal fixation or total elbow arthroplasty for the treatment of low transcondylar fractures are needed in the future.

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Infection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems.</p><p><b>METHODS</b>We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients' data were collected to evaluate the clinical outcome.</p><p><b>RESULTS</b>All patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session.</p><p><b>CONCLUSIONS</b>Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.</p>

Choices to treat fracture of distal humerus in the elderly patients / 中国骨伤

Fractures of distal humerus in elderly patients are difficult to treat, as diminished bone mineral quality and increased trauma-associated articular surfaces destruction may make stable joint reconstruction even more difficult. In active patients, internal fixation is still a primary choice because of use age of total elbow replacement, but disagreements have still existed on how to treat these fractures in elderly patients. In the past years, treatment of fractures of distal humerus make much progress, including the introduction of dual plates fixation, widespread application of three-dimensional CT reconstruction, recognition of complicated fractures, understanding of the parallel plate technique, application of periarticular plates, and the selective use of total elbow arthroplasty. This article is an overview in treating options of fracture of distal humerus in the elderly patients by review the civil and overseas involved literatures.

Clinical study to the cannulated screws with fluoroscopy in the operation of femoral neck fractures / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the safe distance from the tip of the cannulated screw to the apex of the femoral head, and to avoid cutting out of the cannulated screws from the femoral head.</p><p><b>METHODS</b>From November 2007 to April 2008, the placement configuration of the cannulated screws in the femoral head on the anteroposterior (AP) and lateral view was investigated. And the relation between the three-dimensional configuration and the two-dimensional perpendicular view of the femoral head to establish a solid geometry formula was analyzed. According to the configuration, the distances from the tips of different cannulated screws to the apex of the femoral head to confirm the screws placement within the femoral head was measured.</p><p><b>RESULTS</b>The actual risk of cutting out of the cannulated screws varied according to the different placement of the cannulated screws in the femoral head, even if the screw tips were within the femoral head on the AP and lateral radiograph. The mean diameter of femoral head was 49.8 mm. If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw would not cut out as long as it was in the femoral head on the AP view. When the angle was 22.5°on the lateral view, and under 22.5°on the AP view, the distance from the screw tip to the apex of the femoral head would exceeded 2.2 mm. If the angle > 45°on the AP view, the distance would exceed 9.6 mm. When the angle was 45°on the lateral view, and under 22.5°on the AP view, the distance would exceed 8.2 mm. When the angle > 45°on the AP view, the distance would exceed 17.7 mm. When the angle was 67.5°on the lateral view, the distance would exceed 23.1 mm on AP view.</p><p><b>CONCLUSIONS</b>If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw won't cut out as long as it is in the femoral head on the AP view. The angle is larger on the AP and lateral view (especially on the lateral view), and the distance is longer.</p>