Comparison Of The Efficacy Of Two Schemes Of Reduction And Internal Fixation In The Treatment Of Ulnar Coronal Process O’Driscoll Type Ⅲ B Fracture

Objective: To investigate the clinical effect of two different approaches in the treatment of type Ⅲ b ulna coronal process fracture: posterior midline approach and anterior and posterior combined approach,and to clarify the advantages and disadvantages of the two surgical approaches.Methods:The clinical data of O ’Driscoll type Ⅲ b fracture of the ulna coronoid process in Xi ’an Honghui Hospital were analyzed in a retrospective clinical study,A total of 73 patients were included according to inclusion and exclusion criteria,there were 38 males and 35 females;The age ranged from 21 to 61 years,with an average of 38.11±9.12 years.There were 29 cases on the left and 44 cases on the right.Causes of injury: There were 29 traffic injuries,23 falling injuries and 21 falling injuries.Body mass index（BMI）ranged from 16.33 to 31.09,with an average of 23.20±3.65.The time from injury to operation was 2 to 11 days,with an average of 5.22±1.89 days.All patients were divided into two groups according to different surgical plans,including 38 patients in the posterior midline approach group and 35 patients in the anterior and posterior combined approach group.Comparison of two groups of operation time,intraoperative blood loss,postoperative flow,incision healing time,fracture healing time,postoperative 1,3,6months and VAS scores at the time of the last follow-up and elbow,elbow,elbow flexion mobility rotating mobility MEPS ratings,and elbow was,at the time of the last follow-up and record intraoperative and postoperative complications.Results: All patients were followed up for 12-29 months,with an average of20.19±4.16 months.There were no significant differences in operation time,skin healing time,VAS scores at 1 month,3 months,6 months after surgery and the last follow-up between the two groups（P>0.05）.The intraoperative blood loss（132.57±19.61）ml and postoperative drainage volume（51.86±12.19）ml in the anterior and posterior combined approach group were lower than those in the posterior midline approach group（146.05±20.74）ml and（62.50±14.46）ml,with statistical significance（P<0.05）.The fracture healing time of the anterior and posterior combined approach group was（12.31±1.55）weeks,which was shorter than that of the posterior midline approach group（13.21±2.02）weeks,with statistical significance（P<0.05）.In the anterior and posterior combined approach group,the range of motion of elbow flexion and extension was（88.71±11.00）° 1 month postoperatively,（111.14±13.99）° 3 months postoperatively,（121.29±14.31）° 6 months postoperatively and（127.00±13.51）° at the last follow-up.All of them were higher than those in posterior midline approach group（76.18±11.53）°,（98.29±12.21）°,（110.39±13.82）° and（117.11±13.24）°,with statistical significance（P<0.05）;In the anterior and posterior combined approach group,the rotational motion of elbow joint was（91.29±10.17）° 1 month after surgery,（111.29±16.42）° 3 months after surgery,（121.43±17.81）° 6 months after surgery,and（130.29±16.45）° at the last followup.All of them were significantly higher than those in posterior midline approach group（79.87±10.62）°,（100.66±12.15）°,（113.42±11.75）° and（121.45±12.46）°,with statistical significance（P<0.05）.MEPS scores of the anterior and posterior combined approach group were（35.29±9.07）points 1 month after surgery,（56.71±8.82）points 3 months after surgery,（81.83±11.94）points 6 months after surgery and（85.43±10.74）points at the last followup.They were higher than those of posterior midline approach group（28.42±8.15）points,（51.84±8.58）points,（75.66±11.09）points and（80.13±10.69）points,with statistical significance（P<0.05）.The excellent and good rate of elbow joint in the group of anterior and posterior combined approach was 88.6%,including 20 excellent cases,11 good cases,3 fair cases and 1 poor case,which was higher than that in the group of posterior midline approach（78.9%）,including 9 excellent cases,21 good cases,6 fair cases and 2 poor cases,with statistical significance（P<0.05）.There was no statistical significance in the incidence of complications between the two groups（P>0.05）.Conclusion: O ’Driscoll Ⅲ b coronal fracture can be treated by the posterior midline approach and the anterior and posterior combined approach,while the anterior and posterior combined approach have less intraoperative blood loss and postoperative drainage,faster fracture healing time,and postoperative elbow flexion,extension rotation activity and function recovery are better.