encounters such fractures often make us very difficult, but if we truly master the surgical skills, we can also simplify the complex and make it difficult to make it easy.
elbow joint consists of three groups of joints wrapped in one joint capsule, so it is called a complex joint. Among them, humeral trolley and ulnar half-month notch form the humeral ulnar joint, which belongs to the snail joint, and is the main part of the elbow joint; the humeral head and the radial head concave form the brachioradial joint, which belongs to the ball joint; the radial head annular joint surface and the radial notch of the ulnar form the proximal joint of the radial ulnar joint, which belongs to the axle joint. The joint capsule is attached to the bone surface near each joint surface, and the internal and lateral epicondyles of the humerus are located outside the capsule. The joint capsule is loose and weak anterior and posterior, and the tension on both sides is thickened to form collateral ligaments.
996, Hotchkiss described the posterior dislocation of the elbow and the coronal process fractures of the radial head and ulnar coronal process, which was called the "terrible triad of the elbow". Also known as the "terrible triad".
005 Zhang Shimin introduced this new concept of trauma orthopedics in China.
In addition to the above triple injuries, it is often accompanied by tearing of the inner and outer collateral ligament and interosseous membrane of the forearm, radial and (or) ulnar fractures, and separation of the inferior radial ulnar joint. "Three-unit syndrome" is a serious and complex injury, not just a combination of "three" injuries, it can lead to severe elbow joint instability, joint stiffness, , arthritis and other complications. Therefore, it is also called "Terrorist Triad"
This is the latest surgery, which merged ulnar eagle-mouth fracture , and used posterior approach
preoperative imaging
intraoperative situation
postoperative re-examination
1 elbow joint
1 coronary fracture—Regan-Morrey method (1989)
classify according to lateral X-ray film
- Type I: Coronary process apex fracture;
- Type II: Single or complex fractures less than 250% of the coronary process html;
- Type III: Single or complex fractures exceeding 50% of the coronary process.
radial head fracture ——Mason method (1954) classification
- small fractures without displacement or displacement of the edge of the radial head less than 2mm are type I; html l18 radial head partial fracture (some part of the radial head is continuous with the radial stem) with displacement greater than 2mm is type II;
- radial head complete pulverized fracture (the head and the stem have no bone continuous) is type III,
- Johnston (1962) improved the Mason method, adding that the radial head fracture and post-elbow dislocation are type IV.
Therefore, in the elbow joint triple, all radial head fractures are type IV.
terrorist triple treatment principle:
- fixes the ulnar coronal process and radial head fractures to restore the central reduction and stability of the joint;
- reconstructs the structural continuity of the joint capsule and the internal and lateral collateral ligaments and the origin of the flexor and extensor muscles;
- is the basis for reconstructing the stability of the bone joint and soft tissue structure. Carry out rehabilitation exercise early (within 3 weeks) to allow the elbow joint to obtain sufficient daily activities;
- finally achieves the normal function of flexion and extension and forearm rotation amplitude of 100° each.
conservative treatment effect is extremely poor. The standard for conservative treatment is:
① Concentric paraposition of the humeral uln and humeral radial joints
② Radial head fracture <25%,>
③ It has sufficient stability to allow fixation 2-3 Early activity started within the week
surgery indications :
- shifted intra-articular fracture
- closure mode cannot achieve or maintain concentric alignment of elbow joint
- closure arc of movement in the elbow joint after closing and reset (30~ 130 In °) Still unstable
contraindications:
- complies with conservative treatment standards
- suffers from internal medical diseases and cannot operate
surgical approach:
- posterior approach
- lateral approach (or combined with medial approach):
All structures that need to be repaired are on the lateral side (radial head, lateral collateral ligament). Position: lying on the supine position, the arm is placed on the surgical table, the upper airbag tourniquet on the upper arm, the pressure is 250mmHg, and the lower elbow pads are soft to facilitate the incision of the incision, and the front of the coronal process can be exposed through the radial head.
lateral collateral ligament is sleeve-shaped avulsion, and the posterior lateral side of the distal humerus is characterized by a naked area. This is a common mechanism of damage in the lateral structure. Partial repair of the joint has been completed. The avulsed lateral collateral ligament complex is fixed to the lateral condyle of the humerus with anchors or bone drilling.
Postoperative rehabilitation:
- 6 weeks: Flexion and extension exercises in the forearm protrusion position, and do active rotation exercises in the 90° elbow flexion and extension exercises
- weeks: Unlimited flexion and extension exercises and strength exercises
- months: Exercise and work
This is mainly for heavy physical laborers. You can also determine this time limit based on occupations and daily activities
elbow joint function evaluation:
Mayo scoring criteria (Mayo Elbow Performance):
- . Pain 45 points
- . Flexion range 20 points
- . Joint stability 10 points
- . Daily activities 25 points
Excellent: ≥90 points,
75~89 points,
: 60~74 points,
1 : ＜60 points
(Some content is excerpted from ppt: Elbow joint terrorist trilateral signs, orthopedics department of the Second Affiliated Hospital of Guizhou Medical University L H)
My character sketch
My efforts are for your health!
Your health is my biggest gain!
yuncheng County People's Hospital was founded in 1949. It is a level 3 B comprehensive hospital integrating medical care, teaching and scientific research. It has an annual outpatient visits of 550,000 and 40,000 discharged patients.
Yuncheng County People's Hospital orthopedic diagnosis and treatment technology has been rapidly improved, and a green channel for trauma center has been opened. There are more than 1,500 surgical patients this year. In addition to conventional surgery, minimally invasive surgery has developed rapidly. Arthroscopy, vertebral shaping, femoral trochanter closed reduction and fixation, hip and knee replacement, spine and other surgeries are at the leading level in the city.
Orthopedics upholds the spirit of "unity, diligence, pioneering and dedication" and strives to make greater contributions to the physical and mental health of the people in the county.
Chen Chengyu, party member, deputy chief physician, undergraduate degree in Qingyi, deputy director of orthopedics, and subject leader. Specializes in hip and knee replacement; minimally invasive surgery under shoulder and knee, etc. He is good at broken limbs, finger replantation, flap transplantation, various fractures and spinal surgery. I have studied further for many years and accumulated rich experience in trauma joints and sports medicine. We have performed toe reconstitution fingers and various flap surgeries for the first time in our hospital and surrounding counties; we have taken the lead in carrying out knee replacement and arthroscopic surgery for . He has published more than 10 papers at home and abroad, participated in the compilation of 2 surgical books and 2 scientific research projects. He is currently a member of the Orthopedic Branch of the Heze Medical Association of Shandong Province; Orthopedic Group; Sports Medicine Group; Youth Committee of the Orthopedic Branch and the Grassroots Committee of the Shandong Geront Medicine Association.
I ever Tuesday all day orthopedic surgery expert clinic (2nd floor of the outpatient complex building), and you can go to the orthopedic ward on the 12th floor to find me during the rest of the time, because most of the time may be during surgery, it is best to arrive at the ward before 8 am or 2 pm.
