The Clinical Follow-up Research Of Fracture And Dislocation Of Proximal Ulna

Part1Comparison of effectiveness between tension band wiring and platefixation in treatment of different types of olecranon fracturesObjective: To explore the effectiveness between tension band wiring and platefixation in treatment of different types of olecranon fractures.Methods: Between May2007and May2012,75cases of olecranon fractures weretreated with operation,including42cases of non-comminuted fractures and33cases ofcomminuted fractures.23patients with non-comminuted fractures were treated withtension band wiring (Group A) and19patients treated with plate fixation (Group B).18patients with comminuted fractures were treated with tension band wiring (Group C) and15patients treated with plate fixation (Group D). Validated patient-oriented assessmentscores including the Mayo Elbow Performance Score (MEPS), range of motion.Results: All patients were followed up10-40months (means,19.3months). The meanMEPS was89.55±9.92, with satisfaction rate of91%, and the average arc of flexion andextension was (134.20±12.35)o. There were two complications, including one case ofinfection, and one nonunion. The mean MEPS and the average arc of flexion and extensionwere not significantly different between Group A and Group B (P>0.05). But The meanMEPS and mean the average arc of flexion and extension were significantly differentbetween Group C and Group D (P <0.05).Conclusions: Tension band wiring as a classic and economy technique is still aneffective treatment method of non-comminuted olecranon fracture; Plate fixation is moreeffective than tension band wiring in the treatment of comminuted olecranon fractures. Part2Anterior approach for operative fixation of the anteromedial facetfractures of coronoid of ulnaObjective: To explore the effectiveness and complications of suture and suture anchorfixation in treatment of the anteromedial facet fractures of coronoid of ulna throughanterior approach.Methods: Between February2007and February2012, Sixteen cases of anteromedialfacet fractures of coronoid of ulna were treated with operation. According to O’Driscollclassification,4cases of type ⅡA, type ⅡB in7cases,5cases of type ⅡC. Among thepatients of anteromedial facet fractures of coronoid of ulna, seven had simple fractures,three had associated injury of terrible triad (associated with the lateral collateral ligamentinjury in two cases), four had Monteggia fractures, and two had olecranon fractures.Validated patient-oriented assessment scores including the Mayo Elbow PerformanceScore (MEPS), range of motion,and complications.Results: Fifteen patients were followed up10-48months (means,25.3months). Themean MEPS was88.53±8.89, with satisfaction rate of86.7%, and the average arc offlexion and extension was (118±11.23)°, and the the average arc of forearm rotation was138±10.15°. One patients had recurrent elbow instability, and three had slight pain.Conclusions: Fracture of the anteromedial facet of the coronoid was recognized as adistinct type of coronoid fracture in recent years, the fractures can be clearly exposedthrough anterior approach, and the fracture fixation using suture and suture anchor usuallyrestores good elbow functions. Part3Operative treatment of fracture-dislocation of olecranonObjective: To evaluate the effectiveness and complications of plate fixation intreatment of fracture-dislocations of olecranon through posterior approach.Methods: From March2008to March2013, fifteen patients of fracture-dislocationsof olecranon were treated with plate through posterior approach. Six had anterior and ninehad posterior fracture-dislocations, seven had associated injury of radial head fractures,and ten had fractures of coronoid. According to Mayo Elbow Performance Score (MEPS)and range of motion and complications to evaluate elbow function.Results: Fifteen patients were followed up9-49months (means,23.3months), Themean MEPS was85.53±7.46, with satisfaction rate of80.0%, and the average arc offlexion and extension was (105±7.18)°, and the the average arc of forearm rotation was(128±9.25)°. Four patients had ulnohumeral arthrosis, and there were no patients withrecurrent elbow instability.Conclusions: Because fracture-dislocations of olecranon is special, we shouldcorrectly classify them, not be confused with other complex fracture-dislocations of theelbow. The fractures can be clearly exposed through posterior approach, and the fracturefixation using plate fixation usually restores good elbow function.