Dong-Ju Shin

The Surgical Outcomes of the Coronoid Process Fractures of the Ulna Using the Novel “Hooked Kirschner Wire Technique”

Objective: The coronoid process, one of the main constraints providing ulnohumeral joint stability, provides a buttress against posterior displacement of the elbow joint. It is still a challenging problem even for an expert surgeon to fix this small fracture although many fixation methods are introduced and available. Aim: We want to introduce the novel method, “hooked Kirschner wire technique,” and report the clinical outcomes of these methods for the treatment of 24 patients with coronoid fractures with instability of the ulnohumeral joint. Methods: The average age was 46 years (range, 17-79). Twelve cases had initial dislocation of the elbow and 7 of them had radial head fractures (terrible triad). According to O’Driscoll’s classification, there were 3 tip types, 18 anteromedial types, and 3 base types. All cases were treated by the hooked K-wire technique and followed for an average of 12 months (range, 6-27) with outcomes evaluated using the Mayo Elbow Performance Scoring (MEPS) system. Results: One coronoid fracture was not healed and underwent second operation. The average active motion of the elbow joint was 126° (range, 78-160). The average score of MEPS was 96 (range, 80-100). There were 19 excellent and 5 good results. Conclusion: The hooked K-wire technique provided a stable fixation and a satisfactory union for displaced coronoid process fractures with the unstable elbow. This technique has some advantages. First, it is cheap and easy to handle. Second, the small fragment can be fixed medially or laterally. Last, it could be used as a temporary fixator for additional plating or screwing.

The Surgical Outcomes of the Articular Shear Fractures of the Distal Part of the Humerus

Background: Coronal shear fractures of the distal humerus have recently been identified as a “new” type of fracture. Ring and colleagues proposed a classification for this fracture with 5 increasingly complex subtypes. The purpose of this retrospective study is to classify the patterns of articular shear fractures of the distal part of the humerus, according to Ring’s classification, and to analyze the results of the surgical treatments. Method: Thirteen patients with a mean age of 59 (15-88) years underwent operative treatment and were then followed for an average of 21 (12-30) months. All but 2, treated with total elbow arthroplasty, underwent open reduction and internal fixation (ORIF). Results: According to Ring’s classification, there were three type 2, two type 3, five type 4, and three type 5. Average Mayo Elbow Performance Score was 85 (60-100): 5 patients had excellent, 4 had good, and 4 had fair results. Fracture union was achieved in all but 1. The average arc of motion was 103 with an average flexion contracture of 19. In the analysis of the ORIF group, the patients presenting fracture of the posterior aspect of the lateral column showed worse results than those that were not. It was the same for the patient presenting fracture of the posterior trochlea. A precise recognition of these fracture patterns is useful in surgical decision making and choice of surgical technique. Our results suggest that the type of fracture involvement with posterior aspect of trochlea or capitellum can make poor clinical outcomes.