| Objective The fracture of humeral condyle is common one of complex fractures in young adults.It is almost for the high-energy injuries and huge violence.It perform always the comminuted fractures and the serious elbow injury with elbow swelling,pain,deformity,abnormal of the elbow triangle,flexed elbow and bone fricative.The serious fracture of humerus condyle is often accompanied with the obvious displacement,the trochlear surface of the humerus damage,the medial condyle often separated to the lateral condyle,distal humerus showed T or Y type,fractured from shaft of humerus,and rotation fracture.it is for AO type C.Distal humerus anatomic structure is complex,and elbow morphological structure is very irregular.there is some important blood vessels,nervein the front of elbow,and the posterior of elbow is ulna olecranon.The trochlear surface of olecranon is like a wedge inserted into the fork between the two condyles.it is the reason for easily to occur condyle fracture when happening violence.the fracture of humeral condyle is intra-articular fractures,with obvious displacement fracture,articular surface damage,soft tissue injury.Non-surgical treatment is often difficult to obtain satisfactory result.and long-term external fixation easily lead to fracture complications,such as stiff joints,disuse muscle atrophy,myositis ossificans.the most important is the loss of elbow function.the purpose of treatment is to obtain accurate fracture reduction,elbow normal anatomic relationship as far as possible by surgical.on the basis of strong fixation,elbow can obtain early functional exercise,reduce the traumatic arthritis,other joint stiffness and the incidence of complications,restore elbow function as much as possible.So,currently,more and more scholars tend to early open reduction and internal fixation for the fracture of humeral condyle.Intraoperative for the treatment of ulnar nerve mainly includes the in situ independent decompression and neural anterior transposition.one should be regular ulnar nerve anterior transposition to reduce the incidence of ulnar nerve neuritis.the reason is that the ulnar nerve is free,under the skin or muscle.it can be avoided the stimulation of the internal fixation,at the same time decreased ulnar nerve compression caused by fracture,fibrous tissue,the callus and the scar.the soft tissue mat,such as muscle,avoids the ulnar nerve stimulation and compression directly.The Others think that there was no evident difference to the influence of the ulnar nerve between in situ independent decompression or ulnar nerve anterior transposition.according to researchers,it is not needed for ulnar nerve anterior transposition,and through the retrospective study showed that the incidence of ulnar neuritis after ulnar nerve anterior transposition is higher than the original.They think the ulnar nerve anterior transposition from the original location,excessive free destroyed the blood supply of ulnar nerve,are more likely to lead to ulnar neuritis.The purpose of this study is to explore patients clinical curative effect with ulnar nerve anterior transposition or not using the double plate internal fixation for the fracture of humeral condyle.To analysis the influence of intraoperative treatment,to discuss the common postoperative complications and treatment,and rehabilitation of elbow function.Methods Between December 2013 to December 2015,we selected 155 patients with the condyle of the humerus fractures treated with surgical in our traumatic orthopedic department,according to the criteria and exclusion criteria.they were randomly divided into two groups,all groups were surgical with double plate fixation.the observation group is for ulnar nerve in situ release,and the control group ulnar nerve anterior transposition.two groups of clinical curative effect were compared.Results According to the research data statistical analysis,the control group in the operation time is longer than the observation group,the difference was statistically significant(P < 0.01).two groups in terms of hospitalization time,fracture healing time,there was no statistically significant difference(P > 0.05),there was no statistically significant difference in two groups with operative blood loss(P > 0.05),there was no statistically significant difference two groups in elbow joint function recovery(Z = 0.062,P > 0.062);the postoperative complications have incision inflammation,subcutaneous hematoma,loosening of internal fixation and the nerve damage,there was no statistically significant difference in two groups(P > 0.05).complications of two groups were recovery with the symptomatic treatment and comprehensive care.Conclusion The fracture of humerus condyle first suggested surgical treatment.it can be rebuilted joint normal anatomy relation,obtained aligment of bone and the stable fixation,eventually received a painless,satisfactory elbow function.the fracture should be Preoperative sufficiently assessment,and choose a suitable surgical approach,the methods of internal fixation and treatments of ulnar nerve according to the results of the assessment.in postoperative using non-steroidal anti-inflammatory drug is to prevent heterotopic ossification.there should be positive control pain,personalized,professional exercise to recover elbow joint function for rehabilitation program.Except for the initial damage,there is no connection between the humerus condyle fracture and the incidence of ulnar neuritis,postoperative cases of ulnar nerve injury is caused by intraoperative of ulnar nerve pull,internal fixation stimulating,intraoperative destroyed the blood supply of ulnar nerve,and callus and scar tissue adhesion caused to press ulnar nerve.Our research shows that it is not all of the humerus condyle fracture patients with surgery that should need nerve anterior transposition,and it is necessary to take into account with the condition of fracture. |
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