원위 상완골 관절내 골절의 직각 이중 잠김 압박 금속판 고정 = Orthogonal Locking Compression Plate Fixation for Distal Humeral Intraarticular Fractures

국문 초록 (Abstract)

목 적: 원위 상완골 관절내 골절에서 직각 이중 잠김 압박 금속판 고정술의 수술적 치료 결과를 보고하고자 한다. 대상 및 방법: 원위 상완골 관절내 골절로 직각 이중 잠김 압박 금속판 고정술을 시행한 18명의 환자를 대상으로 하였다. AO/OTA 골절 분류상 C2형 8예, C3형 10예였으며, 방사선적 분석과 수술과 관련된 합병증, 주관절 운동 범위 및 Mayo elbow performance score를 이용한 기능적 평가를 시행하였다. 결 과: 평균 골유합 시기는 3.5개월이었으며, 최종 추시상 관절 정복 소실의 경우는 없었다. C3형 골절 환자 중 3명에서 부가적인 수술이 필요하였으며, 이소성 골화염 1예, K 강선 자극 1예가 있었다. 최종 추시상 평균 관절 운동 범위는 7o-122o였으며, 기능적 평가상 탁월 14예, 우수 3예, 보통 1예였다. 결 론: 원위 상완골 관절내 골절에서 관절 골편에 대한 해부학적 정복 및 내고정 후 잠김 압박 금속판을 이용한 직각 이중 금속판 고정술로 최종 추시상 비교적 양호한 치료 결과를 얻었다.

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the surgical outcomes of orthogonal locking compression plate fixation for distal humeral intraarticular fractures. Materials and Methods: This study included 18 patients presenting a distal humeral intraarticular fracture who were treated with orthogonal locking compression plate fixation. According to the AO/OTA classification, there were eight C2 and ten C3 fractures. We evaluated radiologic outcomes, clinical results with range of motion, operation-related complications, and functional score by Mayo elbow performance score (MEPS). Results: The average union time was 3.5 months, and there was no case of reduction loss of articular fracture at the last follow-up. Additional surgical procedures were needed in the three cases of C3 fractures. There was one case of heterotrophic ossification and one case of K-wire irritation. The average range of motion of elbow joint was 7˚ to 122˚, and functional results were graded as 14 excellent, three good, and one fair by MEPS. Conclusion: Anatomical reduction and internal fixation with orthogonal locking compression plate could provide satisfactory surgical outcomes for the treatment of distal humeral intraarticular fracture.

참고문헌 (Reference)

• 1 Kaiser T, "Treatment of supra-and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate : a 2-year follow-up" 20 : 206-212, 2011
• 2 Hoppenfeld S, "Surgical exposures in orthopedics. The anatomic approach" Wolters Kluwer Ed 2009
• 3 O'Driscoll SW, "Supracondylar fractures of the elbow : open reduction, internal fixation" 20 : 465-474, 2004
• 4 Bucholz RW, "Rockwood and green’s fractures in Adults" Lippincott Williams & Wilkins 1059-1064, 2006
• 5 Wilkinson JM, "Posterior surgical approaches to the elbow : a comparative anatomic study" 10 : 380-382, 2001
• 6 Vennettilli M, "Parallel versus orthogonal plating for distal humerus fractures" 37 : 819-820, 2012
• 7 O'Driscoll SW, "Optimizing stability in distal humeral fracture fixation" 14 : 186-194, 2005
• 8 Pajarinen J, "Operative treatment of type C intercondylar fractures of the distal humerus : results after a mean follow-up of 2 years in a series of 18patients" 11 : 48-52, 2002
• 9 Sen MK, "Open reduction and internal fixation of coronal fractures of the capitellum" 32 : 1462-1465, 2007
• 10 Chen RC, "Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures?" 24 : 391-394, 2010
• 11 Imatani J, "Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach" 10 : 554-556, 2001
• 12 Ruan HJ, "Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus" 67 : 1397-1401, 2009
• 13 Galano GJ, "Current treatment strategies for bicolumnar distal humerus fractures" 18 : 20-30, 2010
• 14 Faber KJ, "Coronal shear fractures of the distal humerus : the capitellum and trochlea" 20 : 455-464, 2004
• 15 Charissoux JL, "Comminuted intra-articular fractures of the distal humerus in elderly patients" 94 : 36-62, 2008
• 16 Bégué T, "Articular fractures of the distal humerus" 100 : 55-63, 2014
• 17 Davies MB, "A clinically applicable fracture classification for distal humeral fractures" 15 : 602-608, 2006
• 18 Korner J, "A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates" 18 : 286-293, 2004