Clinical efficacy of mini plate internal fixation through lateral elbow joint approach for Dubberley 3B distal humeral coronal fractures
10.3760/cma.j.cn121113-20240716-00407
- VernacularTitle:肘关节外侧入路微型钢板内固定治疗Dubberley 3B型肱骨远端冠状面骨折
- Author:
Qingwei WANG
1
;
Huasong WANG
;
Huafeng SHI
;
Shouyong HU
;
Qihuang ZHOU
;
Junhai WANG
Author Information
1. 荆门市中心医院，荆门 448000
- Publication Type:Journal Article
- Keywords:
Humeral fractures;
Fracture fixation, internal;
Elbow joint;
Dubberley classification
- From:
Chinese Journal of Orthopaedics
2024;44(23):1532-1540
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy of using micro steel plate internal fixation through the lateral elbow joint approach and traditional posterior olecranon osteotomy approach for the treatment of Dubberley 3B distal humeral coronal fracture.Method:A retrospective analysis was conducted on the data of 35 patients with Dubberley 3B distal humeral coronal fractures admitted to the Orthopedics Department of Jingmen Central Hospital (15 cases) and the Central Theater Command General Hospital of the People's Liberation Army (20 cases) from January 2018 to May 2023. Among them, 23 cases were treated with micro steel plate internal fixation through the lateral elbow joint approach (study group), and 12 cases were treated with traditional posterior olecranon osteotomy approach internal fixation (control group). There were 24 males and 11 females aging from 32 to 64 years old with 18 left elbows and 17 right ones. All of them were fresh fracture cases. The surgical incision length, surgical time, intraoperative bleeding, hospital stay, fracture healing, and incidence of complications between the two groups were recorded and compared. Visual analog scale (VAS) was recorded at 1 week and 1 month after surgery. Function recovery was assessed using Mayo elbow joint function score (Mayo elbow performance score, MEPS) at 3 months and the last follow-up.Result:There was no significant difference in preoperative baseline data between the study group and control group ( P>0.05). Patients in the study group were followed up for 18.7±3.9 months (range 12-47 months) while those in the control group were followed up for 22.3±4.7 months (range 12-52 months). There were significant differences between the study group and control group in the surgical incision length (10.5±0.9 cm vs. 21.2±1.7 cm), surgical time (76.3±4.7 min vs. 98.8±6.1 min), intraoperative blood loss (65.6±10.2 vs. 148.5±14.9 ml), length of stay( 10.4±1.5 vs. 15.8±1.6 d), and fracture healing time (4.2±0.9 months vs. 5.7±1.1 months) ( P<0.05). At the follow-up of 1 week and 1 month, the VAS of the study group (2.7±0.4, 1.3±0.4) were significantly lower compared to the control group ( 3.1±0.5, 1.8±0.6), ( t=2.577, 2.288; P=0.015, 0.029). At the follow up of 3 months, the MEPS of the study group were significantly higher compared to the control group (83.6±1.7 vs. 60.3±4.2, t=23.418, P<0.001). With time, the VAS of both groups decreased significantly, and the MEPS increased significantly ( P<0.05). At the last follow-up, there was no significant difference in MEPS between the two groups (92.3±3.8 vs. 89.5±5.7, P>0.05). At the last follow-up, there were 3 cases of joint degeneration in the study group with no complications of nerve or vascular damage, screw cutting, nonunion of fractures, loss of reduction, joint stiffness, or ectopic ossification, while in the control group, there was one case of delayed healing at the olecranon osteotomy site, one case of poor reduction of the fracture, both treated with immobilization and showing varying degrees of joint stiffness; one case showed ectopic ossification, and a total of four patients experienced elbow joint stiffness. The incidence of complications between the two groups [13.0% (3/23) vs. 33.3% (4/12)] showed significant difference ( P<0.05). Conclusion:The treatment of Dubberley 3B distal humeral coronal fracture through the lateral approach of elbow joint with mini steel plate internal fixation yielded good clinical results with the advantages of short surgical time, reliable internal fixation, satisfying joint function and fewer complications.
