Olecranon sled fixation versus tension band wiring fixation in treatment of Mayo ⅡA olecranon fractures / 中华创伤骨科杂志

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.

Clinical effects of modified open elbow arthrolysis in the treatment of post-traumatic elbow stiffness / 国际外科学杂志

Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.

Locational distribution characteristics and risk factors of heterotopic ossification following traumatic elbow stiffness / 中华创伤骨科杂志

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

Sled board internal fixation for olecranon fractures / 中华创伤骨科杂志

Objective:To investigate the therapeutic effects of sled board internal fixation on the treatment of olecranon fractures.Methods:The clinical data were retrospectively analyzed of the 21 patients with olecranon fracture who had been treated with sled board internal fixation at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from May 2019 to January 2021. They were 11 males and 10 females with 14 left and 7 right sides affected, aged from 18 to 68 years (mean, 42.0 years). By the preoperative Mayo classification for olecranon fractures, one case was type ⅠA, 11 cases were type ⅡA and 9 cases type ⅡB; by the Schatzker classification, one case was type A, 4 cases were type B and 16 cases type C. The operation time and the complications were recorded; at the last follow-up, the range of motion of the elbow joint was recorded and the elbow function and pain were evaluated by the Mayo elbow performance score (MEPS) and visual analogue scale (VAS).Results:The 21 patients were followed up for 13 to 34 months (mean, 19.6 months) after operation. At the last follow-up, the flexion and extension of the affected elbow averaged 139.8° (from 125° to 160°), and the pronation-supination 177.9° (from 160° to 180°). The operation time averaged 77.8 min (from 40 to 135 min). Postoperative olecranon skin discomfort developed in 4 patients, 2 of whom underwent removal of internal fixation; no such complication as internal fixation breakage, screw loosening, incision infection or elbow stiffness was observed in the other 17 cases. At the last follow-up, the MEPS scores averaged 97.9 points (from 85 to 100 points) and the VAS scores 0.2 points (from 0 to 2 points).Conclusion:The sled board internal fixation can result in good therapeutic effects on the treatment of olecranon fractures.

Trans-subscapularis approach for treatment of Ideberg type Ⅰa scapular glenoid fractures / 中华创伤骨科杂志

Objective:To evaluate the trans-subscapularis approach in the treatment of Ideberg type Ⅰa scapular glenoid fractures.Methods:A retrospective analysis was conducted in the 16 patients with Ideberg type Ⅰa scapular glenoid fracture who had been treated via the trans-subscapularis approach at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from December, 2012 to August 2019. X-ray follow-ups were conducted at 2 weeks, 6 to 8 weeks, 3 months and 12 months, and CT follow-ups at 6 to 8 weeks after operation. The Constant-Murley score and visual analogue scale (VAS) were used at the last follow- up to evaluate the postoperative shoulder function and pain in the patients.Results:The 16 patients were followed up for 9 to 101 months (average, 41.2 months). All fractures achieved bony union after 6 to 8 months (average, 6.8 weeks). The Constant-Murley scores at the last follow-up ranged from 85 to 100 points; the lateral internal rotation scores averaged 8.3 points (from 6 to 10 points), showing the level of the T12 spinous process could be palpated by the back of the hand; the VAS scores averaged 0. No patients reported internal fixation failure, postoperative infection or other complications.Conclusion:The trans-subscapularis approach can be used to treat Ideberg type Ⅰa scapular glenoid fractures due to its satisfactory clinical effects.

Treatment of isolated traumatic radial head dislocation after failed close reduction / 中华创伤骨科杂志

Objective:To explore the surgical treatment of isolated traumatic radial head dislocation (ITRHD) after failed close reduction.Methods:A retrospective study was conducted of the 8 patients with ITRHD who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for operation after failed close reduction from January 2011 to December 2020. They were 2 males and 6 females, aged from 15 to 41 years (average, 27 years). The left elbow was injured in 3 patients and the right elbow in 5. At the last follow-up, elbow flexion-extension and forearm pronation-supination were recorded and Mayo Elbow Performance Score (MEPS) was used to evaluate functional recovery.Results:The 8 patients were followed up for 2 to 13 months (mean, 4.5 months). At the last follow-up, elbow flexion-extension averaged 136.9° and forearm pronation-supination 143.8°. None of the 8 patients had significant pain or joint instability. Of them, 7 had good motor function but one reported significant limitation of forearm rotation. All the 8 patients scored a full MEPS mark.Conclusions:If close reduction failed, ITRHD should be treated in time by operative treatment the efficacy of which is reliable. Fixation of the proximal radial-ulnar joint with Kirschner wire should be avoided. Early exercise for full range of elbow motion is necessary.

TiRobot navigation for hinged external fixation in elbow arthrolysis / 中华创伤骨科杂志

Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.

Effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis / 中华创伤骨科杂志

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.

Open reduction and internal fixation for OTA/AO-C open and closed fractures of distal humerus / 中华创伤骨科杂志

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

Research progress in revision surgery after total elbow arthroplasty / 中华创伤杂志

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

Efficacy of total elbow arthroplasty through Diamond-Pop approach for treatment of elbow trauma or arthritis / 中华创伤杂志

The most common indications for total elbow arthroplasty (TEA) are rheumatoid arthritis, osteoarthritis, and post-traumatic arthritis. However, with the rapid development of the prosthesis and surgical techniques, the indications of TEA have been expanded to post-traumatic instability, failure of internal fixation, and acute comminuted distal humeral fractures in elderly patients. The most common complications of the classic Bryan-Morrey approach are postoperative ulnar nerve symptoms and weakness of the triceps muscle. Although the triceps-sparing approach enters the elbow joint through both sides of the triceps and retains the triceps brachii, it adds the operation difficulty and there still exist problems regarding postoperative ulnar nerve symptoms, extensive subcutaneous dissection, and large amount of drainage. In September 2018, Professor O'Driscoll introduced his modified small tongue-shaped flap approach, named as Diamond-Pop approach, but it has not been reported yet in recent literatures. The authors conducted a retrospective case series study to evaluate the clinical outcomes of 20 patients with elbow trauma or arthritis treated by TEA using this approach in Beijing Jishuitan Hospital from September 2018 to September 2019.

Diagnosis and treatment of chronic elbow dislocation / 国际外科学杂志

Chronic elbow dislocation has a low incidence, but high disability rate, often leads to complications such as stiffness and instability, whose management is still a huge challenge in orthopedics traumatology. The mainstream strategy now is to reduce the elbow after extensive soft tissue release, repair or reconstruct collateral ligaments, stabilize the elbow with a hinged external fixator, and start rehabilitation as soon as possible. However, as evidence supporting treatment approaches comes mostly from small case series and case reports, controversies still remain in some intraoperative issues, such as the choice of surgical approach, the indications and methods of triceps lengthening and the reconstruction of ligaments. Combining relevant literature and clinical experience, the authors discussed the research progress in diagnosis and treatment of chronic elbow dislocation, suggesting that clinical doctors should focus on prevention rather than treatment of this disease, and advocated further reducing the incidence and disability rate of chronic elbow dislocation.

Recent progress in diagnosis and treatment of hyperparathyroidism / 国际外科学杂志

Hyperparathyroidism is a secondary or primary endocrine disorder.In recent years,the incidence of hyperparathyroidism in China is increasing.Clinical manifestations tend to be multi-systemic injuries,which poses challenges for patients and clinicians.At the same time,with the advancement of medical science and technology,new detection means and innovative therapies are emerging.In this paper,recent progress of diagnosis and treatments is reviewed to provide basis for clinical work.

Application of enhanced recovery after surgery in treating Gustilo type Ⅰ&Ⅱ open distal humeral fractures / 国际外科学杂志

Objective To compare the function outcome and complication of emergency operation and staged operation with enhanced recovery after surgery (ERAS) for Gustilo type Ⅰ &Ⅱ open distal humeral fractures.Methods Retrospective analysis of 22 patients with Gustilo type Ⅰ & Ⅱ open distal humeral fractures who were treated in Department of Orthopeaedic Trauma,Beijing Jishuitan Hospital from July 2013 to June 2017 was conducted.There were 18 males and 4 females,aged (42.5± 13.0) years,with an age range of 14-65 years.According to different treatment methods,all patients were divided into two groups:emergency operation group (n =6),direct internal fixation after emergency debridement;staged operation group (n =16),emergency debridement and suture,performed the second period of fixed treatment after the soft tissue condition to improve.Patient's waiting time from emergency to surgery,fasting time,surgery time,intra-op blood loss,hospital stay time,elbow range of motion,Mayo elbow performance score (MEPS),secondary surgery rate and complication at the last outpatient visit at 1,3,6,12 and June 2018,post-operatively were recorded.The measurement data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),and the independent sample t test was used for comparison between the two groups;the measurement data not conforming to the normal distribution were expressed as [M(P25,P75)].The rank sum test was used for comparison between the two groups.Comparison of count data between the two groups was performed by x2 test or Fisher exact probability method.Results The time from emergency to surgery of emergency group and staged group was [5.1(4.5,7.3) h],[160.0(102.9,221.2) h],respectively,P ＜0.001.Fasting time was [5.1(4.5,7.3) h],[12.1(9.7,13.2)h],P＜0.001.Hospital stay time was [5.5(5.0,6.5) d],[11.5(9.0,13.0) d],P=0.001.These differences were significant.Surgery time was [3.0 (2.0,3.6) h,2.6 (2.0,3.4) h].Intra-op blood loss was [75.0(25.0,225.0)ml,100.0(100.0,200.0)ml].Elbow range of motion was [155.0(141.3,155.0)°,155.0 (143.8,155.0) °].MEPS was [95.0 (83.8,100.0) scores,90.0 (80.0,100.0) scores].Secondary surgery rate was(33.3％ vs.31.2％).Complication rate was (83.3％ vs.68.7％).These differences were not significant (P ＞0.05).Conclusions ERAS's quick emergency surgery for Gustilo type Ⅰ&Ⅱ open distal humeral fractures significantly reduces the waiting time from emergency to surgery,fasting time and hospital stay time.Function outcome is comparable to the staged group.Therefore,emergency surgical procedures are recommended for patients with Gustilo typeⅠ&Ⅱ open distal humeral fractures.

Risk factors for elbow stiffness after open reduction and internal fixation for intercondylar fractures of the distal humerus / 中华创伤骨科杂志

Objective@#To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.@*Methods@#From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.@*Results@#The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.@*Conclusion@#The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating / 中华创伤骨科杂志

Objective@#To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.@*Methods@#From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery.@*Results@#The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05).@*Conclusions@#In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating / 中华创伤骨科杂志

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.Methods From January 2013 to December 2017,54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma,Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration).According to their age,the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5 ± 3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1 ± 5.8 years.The 2 groups were compared in terms of perioperative data,ranges of motion (flextion,extension and rotation),numeric rating scale for pain (NRS),Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm,Shoulder and Hand (Quick-DASH) at the last follow-up,complications and secondary surgery.Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy,combined injury and gender between them (P ＞ 0.05).The young group had significantly more cases of high-energy injury and combined injuries than the elderly group (P ＜ 0.05).All patients were followed up for 33.6 ± 15.0 months (from 12 to 63 months).The total blood loss in the elderly group (643.9 ± 298.7 mL)was significantly less than that in the young group (953.9 ± 554.6 mL) (P ＜ 0.05).At the last follow-up,there were no significant differences between the 2 groups in ranges of motion,NRS or MEPS (P ＞ 0.05),but the elderly group had significantly higher Quick-DASH scores (13.9 ± 14.4 points) than the young group (5.7 ± 8.9 points) (P ＜ 0.05).There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P ＞ 0.05),but the rate of secondary surgery in the young group (37.9％,11/29) was significantly higher than that in the elderly group (4.0％,1/25)(P ＜ 0.05).Conclusions In the treatment of humeral intercondylar fractures,ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Risk factors for elbow stiffness after open reduction and internal fixation for intercondylar fractures of the distal humerus / 中华创伤骨科杂志

Objective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.Methods From January 2013 to May 2017,159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating.They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years).They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not.The stiffness group had extension-flexion and/or pronation-supination ＜ 100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥ 100° and no secondary elbow arthrolysis.Age,gender,fracture side,mechanism of injury,AO fracture classification,open/close fracture,additional fracture,preoperative nerve injury,time from injury to surgery,surgical approach,configuration of plating,medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months).The latest follow-up showed fracture union in all the patients.The stiffness group had 38 patients and the non-stiffness group 121.Multivariate regression analysis showed that high energy trauma (OR =3.141,95％ CI 1.396 ～ 7.070,P =0.006) and time from injury to surgery ＞ one week (OR =2.596,95％ CI 1.123 ～ 6.000,P =0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.Conclusion The patients with high energy trauma and time from injury to surgery ＞ one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury / 中华骨科杂志

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury.Methods From March 2012 to December 2015,5 patients with established Essex-Lopresti injury,whose radiuses had moved proximally since radial head had been resected in the earlier operation,were operated in our department,including 4 males and 1 female,aged from 25 to 50 years (average,38.8 years).The interval from the radial head resection to the operation in our department was 2 to 7 months (average,4.6 months).All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress,and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint.2 of the 5 cases acquired distal radial-ulnar joint stability after reduction,and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks.The Mayo elbow and wrist function score were used to evaluate pre-and post-operative function,with recording the range of motion of the elbow,forearm and wrist.Results All the 5 patients were followed-up for 24 to 60 months (average 45 months).The Mayo elbow function score was improved from preoperative 62 (range,45-75) to 96 (range,80-100) at the latest follow-up.The Mayo wrist functional score was improved from 54 (range,15-65) to 81 (range,55-90) at the latest follow-up.All patients got significant improvement of involved upper extremity function,without proximal shifting of radius,radial head prosthesis failure or instability of the distal radio-ulnar joint.Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary.

Conservative treatment for Mason Ⅱ and Ⅲ type of radial head fractures without bony block / 中华骨科杂志

Objective To discuss the efficacy of conservative treatment for Mason Ⅱ and Ⅲ type of radial head fracture without bony block.Methods From January 2009 to March 2016,42 patients with type Ⅱ and type Ⅲ radial head fractures but no bony block were included,and there were 20 males and 22 females,18 cases on the left side and 24 cases on the right side.The average age was 32.32±13.62 (range,15-51) years old.Mason type Ⅱ were in 33 cases,while type Ⅲ 9 cases.All were treated by short-time immobilization combined with early functional exercise.When taking exercise,oral analgesics were used to relieve pain to less than 3 points of visual analogue scale (VAS) which allowing active activities combined with gentle passive activities to reach full range of motion.Results The average follow-up time was 35.13±8.56 (range,4-82) months.37 patients had a normal function 2 months after injury,while 5 cases had extension limitation at final follow-up,but less than 30°,without flexion and rotation restriction,no influence on daily life and work.Mean flexion was 136.26°±5.43° (range,130°-140°);mean extension was 3.36°± 14.13° (range,30°-overextension 10°);average flexion and extension ROM was 133.25°± 16.43° (range,100°-150°);average pronation was 87.67° ±6.32° (range,80°-90°);mean supination was 90°;average rotation range of motion 177.63°±5.39° (range,170°-180°);Mayo elbow performance score (MEPS) was 100 points,and the excellent and good rate 100％.No obvious symptoms of pain were found.There were no nonunion,avascular necrosis and joint degeneration.Conclusion By pain relief and strict examination of patients with Mason Ⅱ and Ⅲype of radial head fracture to determine whether there is bony block,if there is,the patients have to be treated surgically,if there is no bony block and separation displacement,even severe comminuted radial head fractures can be treated conservatively.By short-time immobilization and reasonable rehabilitation,the elbow function can be restored to normal or near normal,with no nonunion,avascular necrosis,joint degeneration and other complications.