Efficacy comparison of lateral elbow dislocation approach and non-dislocation approach for reduction and internal fixation of distal humeral coronal fracture / 中华创伤杂志

ABSTRACT

Objective:To compare the efficacy of lateral elbow dislocation approach with non-dislocation approach for open reduction and internal fixation of distal humeral coronal fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with distal humeral coronal fracture admitted to Qilu Hospital (Qingdao) of Shandong University from January 2018 to October 2021, including 10 males and 16 females, aged 15-80 years [(51.6±4.9)years]. According to Dubberley classification, there were 10 patients with type 2A, 5 with type 2B, 6 with type 3A and 5 with type 3B. Overall, 12 patients were operated via lateral elbow dislocation approach (dislocation approach group) and 14 via lateral elbow non-dislocation approach (non-dislocation approach group). The operation time, intraoperative bleeding volume, incision healing, three-dimensional CT assessment of the reduction within one week after surgery (separation or step>2 mm as poor), Mayo elbow performance score (MEPS) at 3 months after surgery and fracture healing at the last follow-up were recorded in both groups. Complications were also compared between the two groups.Results:All patients were followed up for 3-18 months [(10.5±3.3)months]. The operation time was (146.9±15.5)minutes in dislocation approach and (122.7±11.1)minutes in non-dislocation approach group ( P>0.05). The intraoperative bleeding volume was (113.3±9.7)ml in dislocation approach and (112.9±10.1)ml in non-dislocation approach group ( P>0.05). All incisions healed uneventfully in stage I. All patients had good reduction in dislocation group, while only 7 patients had good reduction and the other 7 patients presented a separation or step>2 mm in non-dislocation group ( P<0.05). The MEPS was (90.0±1.4)points in dislocation approach group at 3 months after surgery, including 9 patients being rated as excellent and 3 good, with the excellent and good rate of 100%. In constrast, the MEPS was (78.9±2.9)points in non-dislocation approach group at 3 months after surgery, including 5 patients being rated as excellent, 4 good, 4 fair and 1 poor, with the excellent and good rate of 64.3% ( P<0.05). All fractures were healed at the last follow-up. In non-dislocation approach group, osteoarthritis occurred in 7 patients, including 3 with screw protrusion, 2 with heterotopic ossification and 2 of advanced age with osteophyte formation around the joint. In dislocation approach group, osteoarthritis occurred only in 2 patients of advanced age, showing osteophyte formation around the elbow joint, with no screw cutting or heterotopic ossification. Conclusion:For distal humeral coronal fracture, the lateral elbow dislocation approach is able to provide complete exposure of the articular surface, obtain anatomic reduction, restore elbow function and reduce complications when compared with the non-dislocation approach.