The pronator teres and the flexor carpi radialis interval approach for operative fixation of ulna coronoid process fractures - 26/03/21
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Highlights |
• | There is a consensus that surgical reduction and fixation as well as ligamentous injury repair is optimal for patients to restore good elbow function with coronoid process fracture. Various approaches and implants have been described. However, there is no universally accepted approach for the fixation of coronoid process fractures. Medial, lateral, posterior, anterior and anteromedial approaches, as well as a combination of these, have been increasingly reported, whereas the pronator teres and the flexor carpi radialis interval approach is seldom used and rarely reported. |
• | We consider this approach having the following advantages: firstly, a limited skin incision (the wound is smaller due to operation in the intermuscular spatium), the surrounding soft tissue peeling leads to less trauma, which is conducive to early postoperative rehabilitation; secondly, excellent exposure and permits to directly reduce and fix the fracture using a mini-plate or screw; thirdly, the anterior fascicles of the ulnar collateral ligament can be protected during the operation, and the anterior fascicles of this ligament can also be detected and repaired using the same incision in case of any injury; and lastly, the forearm medial cutaneous nerve is protected during the operation, and there is no need to separate important structures such as the ulnar nerve, median nerve, and brachial artery. |
• | Our clinical experience has led us to believe that the pronator teres and the flexor carpi radialis interval approach appears to be less traumatic, safe, convenient, and technically easier while allowing adequate exposure of all potential fracture subtypes of the coronoid process. |
Abstract |
Background |
The optimal approach for the fixation of coronoid process fractures is unknown. We present the advantages and the clinical effect of the pronator teres and the flexor carpi radialis interval approach for the treatment of ulna coronoid process fractures.
Methods |
The patients, who had operative treatment of closed ulna coronoid process fracture by the pronator teres and the flexor carpi radialis interval approach between January 2011 to December 2016, were studied retrospectively. Seventeen consecutive patients had received surgical fixation by screws or a mini-plate through the above approach, of whom were 16 males and one female with an average age of 36.7 years (range, 21–58 years). There were 11 cases of type II and 6 cases of type III according to the O’Driscoll classification, of which, 6 patients had combined elbow dislocation, 2 patients showed elbow instability after fixation, and one had another incision to repair the lateral collateral ligament, and received a hinged external fixator. The other patient only received a hinged external fixator for 4 weeks. Mayo Elbow Performance Score (MEPS) was used to assess the function of elbow for each patient at the final follow-up.
Results |
Mean follow-up was 28.7 months (range, 24–38 months). Fracture union was achieved in each patient; the average time to radiologic union was 14.2 weeks (range, 12–16 weeks). At the final follow-up, the elbow extension degree of the affected side was (3.88±2.96°), reaching 98.1% of the normal side, and the flexion degree was (131.59±4.93°), reaching 98.16% of the normal side. The forearm pronation was (82.94±3.86°), reaching 94.31% of the normal side, and the supination activity was (82.12±3.82°), reaching 93% of the normal side. According to the MEPS, the functional recovery of the injured arm was assessed as excellent in 16 cases, and good in one. None of the patients showed any neurovascular or deep infections and no heterotopic ossification was found.
Conclusions |
The pronator teres and the flexor carpi radialis interval approach has the advantages of simplicity, safety, minimal invasion, excellent exposure, and good postoperative function recovery for ulna coronoid process fracture.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Ulna coronoid process fracture, Operative approach, The pronator teres, The flexor carpi radialis
Abbreviations : PT, FCR, PL, FCU, MCL, LCL, MEPS
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Vol 107 - N° 2
Articolo 102610- aprile 2021 Ritorno al numero
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