The Effect Of Three Surgical Approaches On The Treatment Of Elbow Joint With The Type-C Distal Humeral Fracture

Objective:To discuss the Olecranon Osteotomy of Ulna(OOU)and Bilateral Triceps Brachii Approach(BTBA)and Triceps Splitting Approach(TSA)for the fracture of type-C of AO classification of the distal humeral fracture in the Grading system of HSS/HSS2 to access the status of elbow joint function;Methods:Include 42 patients with the type-C of AO classification of the distal humeral fracture from January 2017 to July 2018 in the Trauma orthopedics of our hospital.To use case-control analysis,and collect the clinical data of the patients.Including 23 males,19 females;aged 14-64 years,mean 36.48 years old.And according to AO/ASIF fracture classification:11 cases of C1 type,16 cases of C2 type,15 cases of C3 type,and the patient group have been used three different surgical approaches to treat the distal humeral fracture:10 cases of TSA(group A),15 cases of BTBA(group B),and 17 cases of OOU (group C),For the basic data,surgical approach,operation time,intraoperative blood loss,and the effect and grading system of elbow joint function and the recovery of elbow joint,analysis them;Results:The patients in this group were followed up for 45 days,90 days,180 days,and 365 days in Postoperative,with an average of 192 days.The scores of the elbow joint function scores(HSS,HSS2)? 80 were 61.90%?69.04%?71.43%?78.57%;Follow-up at 12 months postoperatively:2 cases of traumatic arthritis,Give them analgesia by etoricoxib tablets;4 case of obvious elbow joint stiffness,2 of them required elbow joint Loosening in the external hospital,At the time of follow-up,the joint activity improved significantly.In one case,the tension band of Kirschner wire was exposed,but the skin around the wound did not increase in skin temperature.Therefore,the patient came to our hospital to remove the internal fixation device and check the wound in 15 months after the operation.There was no infection tendency in the exposed part of the tension band of the Kirschner wire;the other patients had no tendency to be infected,loose of the internal fixation device and fractured;the patient was followed at 12 months after the operations:all patients had statistical of elbow joint score(HSS,HSS2):Excellent in 19 cases,good in 14 cases,medium in 9 cases.Conclusion:We performed an analysis of the elbow function scores and joint function of 42 patients after 3 different surgical approaches and both were fixed with double plates.We found that the effect of OOU is better than TSA and BTBA for the fracture of the fracture of type-C of AO classification of the distal humeral,and the olecranon osteotomy can be found that can fully exposed the joint suface of elbow joint,while avoiding direct and indirect damage to the triceps,effectively protects the triceps tendon and transforms the muscle healing in the area into bone healing,which is more conducive to patients to do early exercise of the elbow joint.Especially for the C3 fracture in AO/ASIF classification,has a more obvious advantage;and the operation is routinely fixed with double plate,and the Kirschner wire is used for the end of the olecranon osteotomy.Which is more conducive to the early functional exercise of the elbow joint of the patient,further avoiding complications such as joint stiffness;Therefore,the fracture of type-C of AO classification of the distal humeral,appropriate surgical procedures and specific surgical plans should be evaluated according to the patient's fracture,how to make the postoperative patients perform functional training of the elbow joint as early as possible to avoid complications such as joint stiffness and traumatic arthritis,and for the C3 type of humeral intercondylar fractures,whether the OOU,BTBA and TSA should be used to compare the recovery of the joints,and the occurrence of surgical complications is the focus of further research;...