| Part1 Perpendicular plate for the surgical management of AO type C distal humerus fracture through the approach of triceps tongue-shaped flapObjective: To explore the surgical management and its results of AO type-C distal humerus fracture through the approach of triceps tongue-shaped flap with perpendicular plater.Methods: From June 2009 to June 2013,39 patients of AO type-C distal humerus fracture were treated surgically through the approach of triceps tongue-shaped flap with perpendicular plater.The patients were 12 males and 27 females with a mean age of 42.6years(range 18-73 years), According AO classification,type-C1 were found in 16 cases,type-C2 in 15 cases, type-C3 in 8.Results: Eighteen patients were followed up from 9 months to 26 months( average14.8 months), of these 38 patients, all the osteotomies healed in 18 weeks averagely(range 12-24 weeks). The function of the elbow( according to Mayo scale) showed excellent in 22 cases, good in 10, fair in 3 and poor in 3, the good-excellent rate was84.2%.Conclusions: The approach of triceps tongue-shaped flap with perpendicular plater is effective to the treatment of the AO type-C distal humerus fracture Part2 Approaches of triceps tongue flap and olecranon osteotomy for thetreatment of intercondylar fracture of humerusObjective: To study the effects of two approaches of triceps tongue flap and olecranon osteotomy for the treatment of intercondylar fracture of humerus.Methods: From Feb 2009 to Oct 2013,31 patients of intercondylar fracture of humerus were treated surgically through the approach of of triceps tongue flap(16 cases) or olecranon osteotomy(15 cases),and the postoperative elbow function、complications and the strength of the triceps were compared.Results: 29 patients were followed up from 9 months to 24 months( average 13months). In the group of triceps tongue flap, 2 patients had transient ulnar nerveplasy. 2stiff joints. In olecranon osteotomy group, in 2 patients, Kirschner wires exited and protruded the skin. 1 elderly patients had not yet healed of osteotomy after surgery for 12 weeks. with plaster fixation for 4 weeks,the osteotomy healed, but he had stiff joint last. In triceps tongue flap group,14 patients received isokinetic muscle testing by CON-TREX.We find the strength of the triceps in the side of the sick decline 15.2% compared with the other side when isotonic contraction and decline 19.9% when isometric contraction. Elbow function was evaluated by using Mayo, for triceps tongue flap group:excellent in 9cases,good in 2,fair in 1 and poor in 2,and the excellent and good rate Was 78.6%;for olecranon osteotomy group:excellent in 9 cases,good in 3,fair in 3 and poor in 1.and the excellent and good rate was 80.0%. There was no significant difference between the two groups(P﹥0.05).Conclusions: The approach of olecranon osteotomy is batter than triceps tongue flap for the treatment of intercondylar fracture of humerus, but for elderly patients, it has the poor healing capacity, so this approach should not be the first choice for elderly patients with osteoporosis.Part3 Operative treatment of fracture-dislocation of olecranonObjective: To quantitatively analyze the security of the screw in the posterior part of the lateral condoyle through measuring the changes of the gray value in different follow-up time X-ray around the screw of the patients who are with intercondylar fracture of humerus..Methods: According to the inclusion criteria, 30 patients of intercondylar fracture of humerus and osteoporosis were treated surgically in our hospital from September 2009 to November 2012 were obtained, the patients were 5 males and 25 females with a mean age of 68.1 years(range from 55 to 83), the patients with left elbow were 16 and the right were 14. All patients were closed fractures. They are divided into two groups. The plate and screws are placed in the posterior part of the lateral condoyle in 14 patients form the Group A(2 males and 10 females with a mean age of 69.4years),the others form the Group B(3 males and 15 females with a mean age of 66.9years).Age, gender and diagnosis after operation in patients of two groups were matched.The X-rays after surgery were obtained.The gray degrees of X-ray in patients of two groups were measured with computer image analyzing, relative values were obtained. The average gray degrees of1.0-2.0cm2 area around the screw of the distal humerus, We use SPSS13.0 statistical software to do data statistics. We use the patient’s own comparison, i.e.,comparing the gray value in the same location of the X-rays during the different follow-up date. We use Paired t-test to compare the data. If P<0.05, we consider that there are statistically significant.Main outcome measures:Relative changes of gray values in different parts of distal humerus in two groups, one group is the patients with operation after three days、the other group is follow-up group(6 months after operation, one year after operation).Results: All 30 patients have been followed-up, the follow-up time is from 9 months to 26 months,the follow-up data all entered the analysis of results, The two followed-up gray values ??at the distal humerus are more higher than the one after three days.contrast the changes of gray value after surgery in 6 months with the one in three days, the changes of gray value in the poster lateral part of the humeral condoyle is greater than the humerus group, the difference was not statistically significant(P> 0.05)contrast the changes of gray value after surgery in a year with the one in three days, the changes of gray value in the poster lateral part of the humeral condoyle is greater than the humerus group,the difference was not statistically significant(P> 0.05)contrast the changes of gray value after surgery in a year with the one in 6 months, the changes of gray value in the poster lateral part of the humeral condoyle is greater than the humerus group, the difference was not statistically significant(P> 0.05).Conclusions: There is a potential weakness of plate fixation in the poster lateral aspect of the distal condoyle for the distal humerus fractures associated with osteoporosis patients, So, we consider that it’s better to use the parallel plate fixation for the patients of distal humerus fracture.Part4 The influencing factors of ulnar neuritis occurred after distalhumerus fractures: A Meta-analysisObjective: To explore the influencing factors of ulnar neuritis occurred after distal humerus fractures and provide the basis for clinical selection of proper operation method。Methods: The literature about distal humerus fracture were searched at home or abroad from Jan 1990 to Dec 2014. According to established inclusion and exclusion criteria, literatures met evaluation criteria were selected, and the data were analyzed with Meta analysis。Results: 39 retrospective clinical trials were included in this study: there are 37 study(487 elbows in SD group /556 elbows in AT group) formed the group of columnar fracture and 7 study in the other group; there are 14 study(193 elbows in SD group /162 elbows in AT group) formed the Olecranon osteotomy group and 12 study(128 elbows in SD group/131 elbows in AT group)in the other group. This Meta-analysis showed that the rate of ulnar neuritis in these study was 7.04%.there is no difference between AT group and SD group, the same as the selection of operation approach, but the type of fracture.Conclusions: In our study, the only risk factor influence ulnar neuritis was the type of fracture,but not the operation approach or the treatment of ulnar nerve. |
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