The Comparative Study On Effects Of Anterior Approach And The Medial Approach In Treating Anteromedia I Facet Fracture Of The Coronoid Process Of Ulna

Objective:To compare the outcome of the anterior approach and the medial approach for the treatment of anteromedia I facet fracture of the coronoid process of ulna.Methods:Retrospective analysis of the clinical data of the patients with anteromedial facet fracture of the coronoid process of ulna from December 2011 to Sep 2015 in our hospital who was trested with operation,39 patients were included.According to the different surgical approach was divided into two groups:group A of 18 patients with the medial approach, group B of 21 patients with the anterior approach.Comparative analysis was performed for two groups of intraoperative blood loss, fracture clinical healing time, elbow function activity,complications and so on.Results:The incisions all healed by first intension,all fractures healed and no vascular injury,infection and internal fixation failure. The patient with O 'Driscoll ?c fracture in groud of the anterior approach had median nerve injury(recovery 3 months after the operation) in 4 cases, 1 case of heterotopic ossification after the operation.There was no nerve injury and heterotopic ossification occurred postoperatively in the rest patients.There was no statistically significant difference between the two groud in the intraoperative blood loss, fracture clinical healing time, forearm pronation and supination, expand and the Mayo score.The patients of O 'Driscoll ?a fracture which treated by the anterior approach, the forearm flexion range(108.8±2.5) ° was better than that of the medial approach group(101.0 ±1.4) °(P < 0.05), the Mayo score(98.7±2.5) was better than that of the medial approach group(90.0 ±0.0)(P < 0.05), there was no statistical difference between the intraoperative blood loss to that of the medial approach group;the patients of O 'Driscoll ?b fracture which treated by the anterior approach, the forearm flexion range(115.2±4.8) ° was better than that of the medial approach group(104.0±4.7) °(P < 0.05), the Mayo score(96.8±2.5) was better than that of the medial approach group(90.0±2.7)(P < 0.05), there was no statistical difference between the intraoperative blood loss to that of the medial approach group;the patients of O 'Driscoll ?c fracture which treated by the anterior approach, the forearm flexion range(102.7±6.6) ° was less than that of the medial approach group(116.3±7.1) °(P < 0.05), the Mayo score(84.5±6.5) was lower than the medial approach group(95.0±3.8)(P < 0.05),the intraoperative blood loss(39.6±7.6) was higher than that of the medial approach group(30.9±8.3)(P < 0.05), the incidence of complications is higher than that of the medial approach group(P < 0.05).Conclusion:The effect of anterior approach in treating the O'Driscoll IIa,IIb fracture is better than the medial approach's;the effect of medial approach in treating the O'Driscoll IIc fracture is better than the anterior approach's.