| Objective: This study statistics the capitulum humeral fractures which associatedwith clinical data. Based on the Dubberley classification, we observe the clinical efficacyof lateral elbow approach open reduction and internal fixation treatment, in order toimprove the level of diagnosis to reduce misdiagnosis; clear damage mechanism; guide theclinical treatment and prognosis; get the standardized treatment recommendations, so as tobetter guide clinical curative effect; clear the feasibility and improve the quality of life ofpatients. All of this research will provide objective basis for reasonable selection oftreatment method.Methods: Data collected from the orthopedics department of the ShandongTraditional Chinese Medicine Hospital. The study included18cases of capitellum humeralfractures clinical data which from January2011to December2013in our hospital. Therewere9male,9female; age14~75years old, average35.78years old;11cases of left side,7cases of right. All patients were fresh closed fractures, without nerve and blood vesselinjury, treated with elbow joint lateral approach. There were4cases of Dubberley Ⅰ Atype,1cases of typeⅠB,2cases of typeⅡA,4cases of typeⅡB,3cases of typeⅢA,4cases of typeⅢB. Treatment:4simple Herber screw fixation;2cases Herber screw andKirschner internal fixation;5cases lateral humeral plate and Kirschner wires or screws orHerber screw fixation;6cases Kirschner combined absorbable rod or absorbable screwfixation;1case Free bone resection and rivet repair. The operation time was2~8daysafter injury. The patients were followed for an average of12months. Long-term effect andthe final follow-up results obtained with the Mayo elbow score standard (MEPS) toevaluate the clinical effect of elbow joint function and the treatment method for evaluationof different operation.Results: All patients preoperative and postoperative X-ray showed anatomical reduction, without nerve and vascular injury in the surgery. All patients were followed upfor process were not found in the capitellum humeral avascular necrosis, without traumaticarthritis or heterotopic ossification, no internal fixation loosening or fracture. The averageactivity of elbow joint after operation: extension0.56°(-15°-10°), flexion117.5°(100°-130°), supination87.78°(80°-90°), supination87.22°(80°-90°), arc118.06°(85°-140°). Follow up data reference Mayo elbow score standard (MEPS)[6](Table1),excellent in13cases, good in5cases; the average score of94.72points. The externalcondyle of humerus comminuted fractures in9cases of posterior (1cases of typeⅠB,4cases of typeⅡB,4cases of typeⅢB), elbow flexion and extension of the average of111.67°, MEPS evaluate the average score of91.11.Conclusions: Elbow lateral approach can clearly reveal the fracture surface and thecapitellum free pulley block bone. Statistics show that, the treatment effects are moresatisfied for DubberleyA, B capitulum humeral fracture, which can be used for the externalcondyle of humerus fracture with posterior Dubberley type B fractures or elbow jointlateral collateral ligament injury patients. There is no important vessels and nerves in theanatomical structure around the clear. The approach is simple, safe and without furtherdamage to the destruction of the blood around the small fracture. This approach is moreflexible to near (far) is extended, conducive to the comprehensive exploration of paralleleffective fracture reduction and rigid fixation, ligament, joint capsule for such damage isalso easy to find and repair. With the fracture healing and fewer postoperativecomplications, patients can active elbow flexion and extension exercises early.Supplemented with Shujin Huoxue traditional Chinese medicine lotion, limb functionrecovered smoothly, can obtain good therapeutic effect. |
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