关键词: 肱骨骨折, 诊断, 鉴别, 治疗结果

Abstract:

Objective：To discuss the diagnosis, differential diagnosis, classification methods and treatment of the capitellar fractures of the distal humerus. Methods: In the study, 28 adult patients with the capitellar fractures were treated in Beijing Jishuitan Hospital from Sep. 2008 to Jan. 2014. There were 10 females and 18 males with an average age of 34 years (range: 14-66 years). According to Dubberley classification: ⅠA type in 6 cases, ⅠB type in 2 cases, ⅡA type in 8 cases, ⅡB type in 4 cases, ⅢA type in 4 cases, and ⅢB type in 4 cases. Sixteen patients were treated with a single Kochr approach, 1 with a lateral approach combined with a medial approach, 2 combined with anterior elbow approach and 9 combined with posterior median approach. All of the fractures were fixed with Herbert screws, 7 cases with support plates, and 4 cases with the hinged elbow external fixator. All of the patients were followed up for clinical examination and radiograph check. They were evaluated with Broberg-Morrey score system. Results: The average follow-up time was 28.5 months (range 12-72 months). The average bone union time was 8 weeks. The average ulnohumeral motion was 112°(60°-150°) and forearm rotation was 145°(100°-170°). The average Broberg-Morrey score was 92.5 points (range: 62-100 points). The excellent and good rate was 91.8%. The complications of traumatic arthritis was in 2 cases and elbow stiffness was in 2 cases. Conclusion: Attention should be paid to the diagnosis and differential diagnosis of capitellar fractures without missing the combined injury. According to Dubberley classification, appropriate surgical approach and the internal and external fixed methods could be chosen. Early postoperative, reasonable and effective exercise is helpful to the recovery of elbow joint function.

Key words: Humeral fractures, Diagnosis, differential, Treatment outcome