| Objective: This experiment is based on the current arthroscopic surgical method for treating coronoid fracture and Outerbridge-Kashiwagi ulnohumeral arthroplasty.We explore the feasibility of arthroscopic treatment of coronoid fracture by establishing the portal from olecranon fossa to coronoid fossa.Methods: Eight fresh frozen adult elbow specimens were used.There were 5 males and 3 females,including 3 left,5 right,and mean aged(48.88±13.05)years.The specimens were randomly divided into two groups,4cases in each group.The specimens of group A simulated the fixation of coronoid fractures by kirschner wire inserted in the anteroposterior direction,and the specimens of group B simulated the fixation of coronoid fractures by kirschner wire inserted in the posteroanterior direction.Arthroscopy equipment was installed.All specimens were established with the direct lateral portal,the proximal anteromedial portal,the proximal anterolateral portal,the posterolateral portal,the direct posterori portal,and a portal from olecranon fossa to coronoid fossa.Under arthroscopic direct vision,the portal from olecranon fossa to coronoid fossa was used as an observation portal and an operation portal to cooperate with the posterolateral portal,the proximal anteromedial portal,and the proximal anterolateral portal,respectively,to simulate the reduction and fixation of coronoid fracture.Coronoid fractures were fixed the anteroposterior direction with Kirschner wires through the portal from olecranon fossa to coronoid fossa in group A.The anterior cruciate ligament(ACL)locator was inserted through the portal from olecranon fossa to coronoid fossa with the help of Kirschner wires to fix the coronoid fracture through the posteroanterior direction.The effectiveness of reduction and fixation of coronoid fracture under different diameters of the portal from olecranon fossa to coronoid fossa was evaluated.Record the angles of the two groups of specimens A and B to establish the portal from olecranon fossa to coronoid fossa,the minimum portal diameter for fixing the coronoid process fracture and the appropriate portal diameter,and the angle of flexion of the elbow when portal from olecranon fossa to coronoid fossa as the operation approach to reduction and fixation of coronoid fracture under direct vision to obtain an appropriate field of view.X-rays views of the specimens after the simulated fixation of the coronoid fracture were evaluated to evaluate the effect of this method on the fixation of the coronoid fracture.Results: 1.Coronoid fracture were simulated and fixed on fresh frozen adult elbow specimens.The portal was established by directing the posterior median portal point behind the elbow from olecranon fossa to coronoid fossa under arthroscopic vision.The portal can be used as an observation portal for reducing and fixing coronoid fracture during surgery,as well as an operation portal.Under the arthroscopic vision,the combination of the portal established from olecranon fossa to coronoid fossa and the posterolateral portal,the proximal anterolateral portal,and the proximal anterolateral portal were successfully used to simulate the reduction and internal fixation of coronoid fracture.Coronoid fracture can be anatomically reduced and firmly fixed by using Kirschner wires through the portal from olecranon fossa to coronoid fossa for anteroposterior direction and with the assistance of the ACL locator through the portal from olecranon fossa to coronoid fossa with the help of Kirschner wires to fix the coronoid fracture through the posteroanterior direction.Moreover,the fixed position of the Kirschner wire was satisfactory observed under arthroscopy.And postoperative X-ray examination showed that the simulated fracture fixation position was satisfactory.However,the anteroposterior direction coronoid fracture fixation makes it easier for the Kirschner wire to pass through the optimal position of the fractured block under arthroscopy.The risk of vascular nerve injury and fractured block bursting is lower than that of the posteroanterior direction fixed coronoid fracture.so smaller fractures can be fixed.With the assistance of the ACL locator through the portal from olecranon fossa to coronoid fossa with the help of Kirschner wires to fix the coronoid fracture through the posteroanterior direction.The deviation of the ACL locator may prevent the Kirschner wire from reaching the optimal fixation position.However,the ACL locator has the function of assisting reduction of fractured bones,more suitable for fixing large fractures.2.There was no significant difference in the direction of the portal from olecranon fossa to coronoid fossa between the two groups of specimens A and B with the angle formed by the proximal humerus shaft on the sagittal plane(P=0.472).There was no significant difference in the angles formed on the radial side(P=0.404).The direction of the portal from olecranon fossa to coronoid fossa of all specimens with the proximal humerus shaft on the sagittal plane were(59.21±2.64)°,the radial side was(26.91±1.52)°.The minimum portal diameter for fixing coronoid fracture is 9mm,and a suitable portal diameter is 12 mm.The flexion angles of the elbow joints in the two groups of specimens A and B were statistically significant when the coronoid fracture were reduced and fixed under direct vision using the the portal from olecranon fossa to coronoid fossa as an operation approach(P<0.001).The flexion angle of the elbow joint in group A was(117.35±2.69)°.The flexion angle of the elbow joint in group B was(88.40±1.52)°.Conclusion: Arthroscopic treatment of coronoid fracture by establishing the portal from olecranon fossa to coronoid fossa is an effective,safe and repeatable surgical technique.It can avoid further damage to the blood supply of the elbow capsule and fracture,and effectively reduce the risk of vascular and nerve injury and fracture burst during the operation.The direction of the portal from olecranon fossa to coronoid fossa of all specimens with the proximal humerus shaft on the sagittal plane were(59.21±2.64)°,the radial side was(26.91±1.52)°.Additionally,the 12 mm portal diameter in the appropriate range may help improve the effectiveness of the surgical procedure.Coronoid fracture can be anatomically reduced and firmly fixed by using Kirschner wires through the portal from olecranon fossa to coronoid fossa for anteroposterior direction when the flexion angle of the elbow joint was(117.35±2.69)° or with the assistance of the ACL locator through the portal from olecranon fossa to coronoid fossa with the help of Kirschner wires to fix the coronoid fracture through the posteroanterior direction when the flexion angle of the elbow joint was(88.40±1.52)°.The risk of vascular nerve injury and fractured block bursting is lower than that of the posteroanterior direction fixed coronoid fracture,so smaller fractures can be fixed.The deviation of the ACL locator may prevent the Kirschner wire from reaching the optimal fixation position.However,the ACL locator has the function of assisting reduction of fractured bones,more suitable for fixing large fractures. |
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