开放手术联合外固定架治疗肘关节僵硬的疗效分析

目的:分析开放手术联合外固定架治疗肘关节僵硬的临床效果。方法:46名实施开放肘关节联合外固定手术治疗的患者中,38人为后正中入路,8人为内侧入路,同时联合使用外固定支架辅助患者早期康复和锻炼。并对全部患者实施常规尺神经松解前置。通过Mayo肘关节功能评分判断治疗前后的疗效。结果:全部患者接受8~24个月的随访。患者在术前肘关节的屈伸活动度为(11.0°±10.5°),术后改善为(117.8°±24.5°);患者的Mayo肘关节功能术前平均为(48.8±10.1)分,术后提升至(89.5±11.6)分,手术前后的两项指标差异明显。结论:开放手术联合外固定架治疗肘关节僵硬可以实现肘关节功能的良好恢复,并且对关节术后不稳存在预防作用,有利于术后的康复锻炼。     

两种手术入路在肘关节松解术中应用的比较

目的 对肘关节松解术时通常采用的后正中入路和内外侧联合入路两种手术切口进行回顾性比较分析.方法自2009年1月至12月由同一小组治疗且获得完整随防的肘关节僵硬患者共41例,采用后正中入路患者21例,男15例,女6例;平均35.8岁(16～70岁);僵硬程度:极重度12例,重度7例,中度2例;8例有尺神经症状.采用内外侧联合入路患者20例,男8例,女12例;平均38.8岁(16～51岁);僵硬程度:极重度11例,重度7例,中度2例;5例有尺神经症状.比较两组患者的松解效果和并发症发生情况.结果 41例患者获得4～15个月(平均7.9个月)随访.采用后正中入路的患者肘关节平均屈伸术前为27.6°±25.7°,术后为111.4°±25.6°;平均旋转术前为152.9°±46.9°,术后为168.1°±19.1°;Mayo肘关节功能评分(MEPS)术前为(65.5±11.5)分,术后为(95.7±6.4)分.内外侧联合入路患者平均屈伸术前为35.5°±25.0°,术后为1 16.5°±19.1°;平均旋转术前为138.0°±55.7°,术后为148.5°±45.6°;MEPS评分术前平均为(66.3±13.0)分,术后为(97.3±7.0)分.两组患者术后肘关节活动度和MEPS评分均较术前有明显改善,差异有统计学意义(P＜0.05);但两组患者手术前、后肘关节活动度及MEPS评分比较差异无统计学意义(P＞0.05).采用后正中入路的21例患者中有5例肘后方形成巨大血肿,有3例肘后伤口裂开,余患者均有轻度的血肿形成.而采用内外侧联合入路的患者中,无一例出现伤口并发症.结论 在肘关节松解术中尽量采用内外侧联合入路,可避免后正中入路时伤口的并发症.     

内外侧联合入路治疗创伤性肘关节僵硬

目的探讨内外侧联合入路肘部松解治疗创伤性肘关节僵硬的手术技巧及临床效果。方法回顾性分析自2009年1月至2014年1月山东省立医院采用内外侧联合入路肘部松解治疗的创伤性肘关节僵硬患者42例,其中男23例、女19例,年龄20~63岁,平均为36.5岁。原始损伤:肱骨髁上骨折5例,肱骨内侧髁骨折3例,肱骨外侧髁骨折4例,髁间骨折6例,尺骨鹰嘴骨折6例,冠状突骨折2例,桡骨小头骨折10例,单纯肘关节脱位4例,不伴有骨折或脱位的软组织损伤2例。手术方法:采用静脉全身麻醉或臂丛麻醉,肘关节内外侧联合切口,彻底松解,25例加用肘关节铰链支架,术后口服消炎痛25 mg,1天3次,持续6周,第2天即开始功能锻炼,8~12周去除外固定架。结果 40例患者获得随访,随访时间12~36个月,平均16个月。肘关节屈伸活动度从术前平均36°提高到术后最近复查的105°,肘部功能根据Mayo评分由术前平均50分增加到87分,患者手术前后的关节功能相比,差异有统计学意义(P0.05)。结论内外侧联合入路可以彻底切除影响肘关节活动的骨赘、瘢痕、关节囊以及部分韧带,松解关节,加用肘关节铰链支架可以稳定肘关节,增加肘关节间隙,有助于早期活动及功能锻炼,从而获得良好临床效果。     

肘关节松解联合铰链式外固定架治疗异位骨化所致肘关节屈伸功能障碍的中期疗效

目的探讨肘关节松解联合铰链式外固定架治疗异位骨化所致肘关节屈伸功能障碍的中期疗效。方法 2014年1月—2017年12月,收治11例肘关节异位骨化导致的肘关节屈伸功能障碍患者。男9例,女2例;年龄14～48岁,平均32岁。左侧6例,右侧5例。初始病因:肱骨骨折5例,尺骨骨折2例,桡骨头骨折1例,桡骨头脱位1例,肘关节恐怖三联征1例,肘关节软组织损伤1例。术前异位骨化导致肘关节功能障碍7～18个月,平均11个月。术前肘关节主动屈伸活动度为(19.6±17.5)°,Mayo评分为(34.1±9.7)分。所有患者采用开放手术松解肘关节关节囊和内、外侧副韧带,清除异位骨化病灶,联合铰链式外固定架固定;术后在铰链式外固定架辅助下行主、被动功能锻炼2个月。术后2个月去除肘关节外固定架。结果 11例患者均获随访,随访时间13～36个月,平均19.1个月。术后切口均Ⅰ期愈合,随访期间未出现明显钉道感染、神经损伤等并发症。末次随访时,X线片示肘关节无新异位骨化形成。患者肘关节主动屈伸活动度为(116.4±16.6)°,Mayo评分为(93.2±7.8)分,与术前比较差异均有统计学意义(t=17.508,P=0.000;t=16.618,P=0.000)。结论对于异位骨化所致肘关节屈伸功能障碍,肘关节松解联合铰链式外固定架治疗能有效改善肘关节屈伸活动度,获得较好中期疗效。     

创伤后肘关节僵硬的外固定支架松解术

目的 总结铰链外固定支架松解术治疗创伤后肘关节僵硬的早期经验.方法 2005年1～6月收治12例创伤后肘关节发生僵硬患者,男8例,女4例;年龄8～56岁,平均40岁.应用铰链外固定支架对患者僵硬肘关节进行松解.结果 所有患者获得16～26个月,平均20.8个月,患者肘关节平均最大屈曲活动度从术前的62.1°改善为术后107.1°,平均最大伸展活动度从术前的32.5°改善为术后21.7°,总平均活动范围从术前的29.6°改善为术后85.4°,Mayo评分从术前44.6分改善为术后80.4分.结论 采用铰链外固定支架松解技术治疗创伤后肘关节僵硬疗效显著,可有效增加僵硬肘关节的最大屈伸活动度及活动范围.     

手术松解治疗创伤后肘关节僵硬初步疗效报告

目的 分析手术松解治疗创伤后肘关节僵硬患者的疗效,并探讨创伤后肘关节僵硬的治疗方法 .方法 本组共12例患者,其中男性9例,女性3例;左侧、右侧各6例.患者平均年龄32岁(16～47岁).原始损伤单纯骨折7例,单纯脱位1例,骨折合并脱位2例,单纯软组织损伤2例.患者伤后以石膏或颈腕吊带固定时间平均3.3周(0～8周).患者受伤至本次手术时间平均6.4个月(1～14个月).术前平均活动度为33.8°(0°～80°).本组患者术前3例前臂旋转受限.4例患者采用后侧入路,6例患者采用内、外侧联合入路,2例采用单纯内侧入路.去除影响肘关节活动的因素,部分患者行上尺桡关节松解.术中尽量达到肘屈伸0°～140°,前臂旋前80°,旋后90°.非常规行尺神经前移.术后第1天开始主动及主动辅助肘及前臂功能锻炼.口服吲哚美辛以预防异位骨化.术前Mayo肘关节功能评分平均70.4分(50～90分).结果 所有患者均获随访,术后随访14～18个月,平均15.8个月,术后平均活动度为120.8°(100°～140°),9例患者(75% )恢复了肘关节屈伸30°～130°的功能弧度.10例患者伸肘受限10°以下,4例患者可达伸肘0°.3例术前前臂旋转受限患者术后旋转功能改善.术后Mayo肘关节功能评分平均98.8分(85-100分).患者皆无异位骨化迹象.结论 术前审慎评估患者肘关节功能情况,术中细致松解,术后早期主动及主动辅助功能锻炼,可以取得良好的临床效果.     

铰链式外固定架在肘关节恐怖三联征治疗中的应用

目的探讨肘关节"恐怖三联征"切开复位内固定后铰链式外固定架固定对肘关节功能恢复的影响。方法回顾性分析自2012-01—2015-06采用切开复位内固定治疗的22例肘关节"恐怖三联征",12例术后石膏外固定(石膏组),10例安装铰链式外固定架(外固定架组)。结果 22例均获得随访,随访时间平均18.5(12~26)个月。末次随访时,石膏组肘关节屈伸(68.5±16.5)°,前臂旋转(85.6±16.1)°,肘关节功能Mayo评分(71.4±4.2)分;外固定架组肘关节屈伸(118.5±22.7)°,前臂旋转(151.3±18.4)°,Mayo评分(92.8±3.6)分。外固定架组肘关节屈伸活动度、前臂旋转活动度、肘关节功能Mayo评分均优于石膏组,差异有统计学意义(P0.05)。结论肘关节"恐怖三联征"切开复位内固定术后铰链式外固定架固定可靠,其牵开作用可维持关节高度,患者可早期主动进行功能锻炼,从而恢复良好的肘关节功能及活动度。     

肘关节松解术结合带轴外固定支架治疗创伤后肘关节僵硬

目的 探讨应用关节松解术结合带轴外固定支架治疗创伤后外源性肘关节僵硬的临床效果.方法 2006年2月至2008年4月采用肘关节松解术加带轴外固定支架治疗16例创伤后肘关节僵硬患者,男10例,女6例;年龄16-42岁,平均30.5岁.原始损伤:肱骨髁上骨折3例,肱骨髁间骨折4例,尺骨冠状突骨折1例,桡骨小头骨折5例,孟氏骨折3例.受伤至松解手术时间平均为13个月.11例采用肘关节外侧入路,4例采用肘关节内侧入路,1例采用内外侧联合入路进行肘关节松解术,术中保留维持关节稳定的主要韧带,彻底清除影响关节活动的因素,恢复关节活动度.松解完成后以带轴外固定支架固定肘关节,早期进行康复锻炼.结果 16例患者术后获平均16个月(13～27个月)随访.所有患者关节活动度从术前平均34°±26°恢复到术后92°±14°差异有统计学意义(t=4.351,P<0.05).Mayo评分由术前平均(42±11)分增加到术后(84±16)分,其中优3例,良8例,中3例,差2例,优良率68.8%,例(87.5%)患者关节功能得到明显改善.术后未发生感染、肘关节不稳定等并发症.1例患者出现短暂的尺神经麻痹,2个月后症状消失.结论 肘关节松解术结合带轴外固定支架治疗创伤后肘关节僵硬可维持肘关节的稳定性和特有位置,可早期进行功能锻炼,促进肘关节功能的恢复.     

Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折的疗效分析

目的探讨切开复位Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折的临床疗效。方法回顾性分析自2013-01—2015-12采用切开复位Herbert钉联合铰链式外固定架固定治疗的9例肱骨小头骨折,观察术后骨折愈合、肘关节功能恢复情况。结果 9例获得平均13.9(9~24)个月随访。术后X线片显示骨折愈合时间平均8.8(8~12)周。末次随访时均无疼痛及关节不稳定,肘关节屈伸活动度平均120°(100°~145°),前臂旋转活动度平均135°(90°~180°)。末次随访时改良Mayo肘关节功能评分:优8例,良1例;Broberg-Morrey肘部骨折疗效评分:优8例,良1例。结论切开复位Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折固定可靠,患者可早期进行功能锻炼促进骨折愈合,可有效预防关节僵硬、异位骨化等并发症。     

侧方与后正中入路松解僵直肘的疗效比较

目的 评估并比较采用侧方与后正中入路松解僵直肘的临床效果.方法 对44例肘关节僵硬患者采用手术松解.其中22例取肘侧方入路,经内侧入路分离关节囊后壁并清理肘后侧鹰嘴窝,经外侧入路分离关节囊前壁及清理桡骨头.22例取肘后正中皮肤切口,完整分离肱三头肌以清理鹰嘴窝,两侧深层显露采用侧方肌间隙入路.结果 44例获得14～52个月(平均23.2个月)的随访.侧方人路:术后肘关节活动度平均为[(108.0±12.4)°,-/x±s,下同],术后Mayo肘关节功能评分平均为(83.4±2.4)分.后正中人路:术后肘关节活动度平均为(95.7±17.3)°,术后Mayo肘关节功能评分平均为(79.2±6.9)分.两组松解疗效差异均较术前有统计学意义(P<0.01),组间术后平均活动度差异有统计学意义(P<0.05),组间术后平均Mayo肘关节功能评分差异有统计学意义(P<0.05).结论 采用侧方或后正中入路的松解方法 ,对僵直肘安全有效.肘侧方入路松解可获得比后正中人路松解更好的临床效果.     

可调节外固定支架治疗高龄开放性肘关节损伤的临床疗效分析

目的探讨应用可调节外固定支架治疗高龄肘关节开放性损伤的临床疗效分析。方法自2013年8月至2019年3月,我们采用可调式外固定支架治疗肘关节开放性损伤高龄患者5例。肘关节开放性损伤包括肘关节后脱位、桡骨头骨折、尺骨鹰嘴骨折、肱骨課骨折、冠状突骨折等病例。术后随访应用May。肘关节功能评分进行疗效评价。结果术后所有患者均获得随访,时间为6-18个月,平均11.5个月,Mayo肘关节功能评分75~100分,平均87分,优良率为80%。其中1例患者出现肘关节屈伸范围40°~115°,基本可满足日常生活需要。所有患者均无明显疼痛、关节不稳定、神经损伤及感染等并发症发生。结论对于高龄肘关节开放性损伤患者,可以把可调节外固定支架技术作为可选择的治疗方案。     

手术治疗肘关节“恐怖三联征”的短期疗效分析

目的探讨手术治疗肘关节"恐怖三联征"的手术方法和临床疗效。方法 2005年6月~2009年2月,本组应用手术治疗闭合性肘关节"恐怖三联征"患者6例。桡骨头骨折按改良Mason分型,Ⅰ型2例,Ⅱ型4例;尺骨冠突骨折按Regan-Morrey分型,Ⅰ型3例,Ⅱ型3例。术中发现肘内、外侧副韧带均有撕裂。按照McKee手术方法,所有患者采用肘内、外侧联合入路进行手术治疗;术后在肘关节屈曲90°和前臂旋转中立位的姿势下,以长臂石膏后托外固定7~10 d,之后开始进行肘关节屈伸和前臂旋转的主动训练。结果术后随访6例,随访时间12~26个月,平均随访时间15个月。6例患者伤口均Ⅰ期愈合;骨折亦复位良好,未见畸形愈合,临床愈合时间平均为11周(8~19周);2例患者术后6个月X线片显示肘关节轻度异位骨化;2例患者术后15个月X线片显示肘关节轻度退行性改变;最后随访时肘关节屈伸活动度(109±12)°,前臂旋转活动度(97±15)°,未发现肘关节僵硬、复发性脱位以及桡神经损伤症状;采用Mayo肘关节功能评估指数对随访患者进行评价,其中优2例,良3例,一般1例。结论肘关节"恐怖三联征"由于伴发损伤多,导致肘关节的严重不稳;只有通过手术治疗,恢复和重建肘关节的稳定结构,同时配合早期的康复训练,才能较好地恢复肘关节的功能。     

Treatment of unreduced elbow dislocations with hinged external fixation

BACKGROUND: The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone. METHODS: Three women and two men (average age, forty-nine years) with an unreduced dislocation of the elbow without associated fractures were treated with open relocation of the joint and hinged external fixation at an average of eleven weeks (range, six to thirty weeks) after the initial injury. The lateral soft tissues, including the origin of the lateral collateral ligament complex, were reattached to the lateral epicondyle in three patients, but no attempt was made to reconstruct the ligaments, tendons, or bone. A passive worm gear incorporated into a hinged external fixator was used to mobilize the elbow initially, and active mobilization was gradually introduced. The hinge was removed at an average of five weeks after the procedure. RESULTS: At an average of thirty-eight months (range, twelve to ninety-eight months), a stable, concentric reduction had been maintained in all five patients, with radiographic signs of mild arthrosis in four. The average arc of flexion was 123 degrees, and all patients had full forearm rotation. The average score on the Mayo Elbow Performance Index was 89 points, with two excellent and three good results. The average scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons outcome instruments (13 and 92 points, respectively) reflected mild residual pain and disability. CONCLUSIONS: Treatment of unreduced elbow dislocations with open reduction and hinged external fixation as much as thirty weeks after the injury can restore a stable, mobile joint without the need for tendon-lengthening or transfer, ligament reconstruction, or deepening of the trochlear notch of the ulna.     

前内侧面尺骨冠状突骨折的手术治疗策略

目的:探讨手术治疗前内侧面尺骨冠状突骨折的手术入路选择、内固定方法及其疗效。方法:自2005年3月至2010年3月,采用手术内固定治疗前内侧面冠突骨折18例,男12例,女6例;年龄19～74岁,平均37.8岁。全部采用切开复位内固定治疗。取肘后正中切口,游离皮瓣后在外侧暴露肘关节外侧副韧带复合体及关节囊,采用不可吸收线缝合法或锚钉技术修复外侧副韧带复合体。根据术前三维重建图像上骨折情况及分型,分别选择3个不同的手术入路,暴露前内侧面冠状突骨折,采用微型钢板及螺钉固定。用MEPS(Mayo elbow performance score)和Broberg&Morrey评分对肘关节功能进行评价。结果:17例获得随访,时间1～6年,平均38个月;骨折均获临床愈合,愈合时间8～16周,平均11.6周。末次随访时,所有患者肘关节没有明显疼痛及不稳定。MEPS评分82～100分,平均(95.4±4.6)分;Broberg&Morrey评分75～100分,平均(92.3±5.8)分。结论:切开复位微型钢板内固定可使前内侧面冠状突骨折达到良好的解剖复位及坚强固定,是治疗前内侧面尺骨冠突骨折的有效方法。     

Characteristics of Elbow Dislocation in Patients with Preexisting Cubitus Varus

BackgroundThe aim of this study was to investigate the clinical presentations, patterns of soft-tissue injuries, and outcomes of treatment of elbow dislocations in patients with preexisting cubitus varus.MethodsFour cases of elbow dislocation in patients with preexisting cubitus varus, which were treated at 3 residency training hospitals, were retrospectively reviewed. Soft-tissue injury patterns were investigated using magnetic resonance imaging (MRI). Clinical outcomes were assessed at an average of 50.8 months (range, 34–82 months) after treatment using the Mayo Elbow Performance Score (MEPS) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score.ResultsThe mean patient age was 49.5 years (range, 33–57 years). All patients had a posteromedial elbow dislocation, which was an indirect injury caused by a fall onto an outstretched hand. One patient had failed closed reduction; 3 others had redislocation or gross instability after closed reduction. Significant tears of the lateral collateral ligament complex and common extensor group were shown in MRI. All patients had surgical treatment including lateral complex repair only (n = 2), repair of both sides'' complexes (n = 1), and corrective osteotomy with lateral complex repair (n = 1). At the final follow-up, the mean MEPS was 92.5 ± 8.7 and the mean QuickDASH score was 4.5 ± 6.4.ConclusionsElbow dislocation in patients with preexisting cubitus varus may present as posteromedial dislocation with acute instability. Surgical treatment of this injury led to acceptable clinical outcomes.     

Interpositional elbow arthroplasty using fascia lata autograft in stiff elbow: Case series of 8 patients

IntroductionConstrain of a total elbow replacement and elbow arthrodesis are too much for the working population to bear. As such interpositional elbow arthroplasty using fascia lata autologous graft to reconstruct the elbow joint is a viable option in this age group.Materials and method8 patients were operated for arthritic stiff elbow, and joint reconstruction was done using fascia lata autologous graft, with out the use of any hinged external fixator. Pre-operative and post-operative functional assessment was done using Mayo Elbow Performance Score (MEPS) and statistically measured using a paired t-test.ResultThere was significant improvement in range of motion in coronal (flexion-extension) and axial (supination-protonation) with p-value of <0.001. The mean pre-operative MEPI increased from 40.6 points to 91.9 points (p < 0.0001). All parameters of MEPI had statistically significant improvement with exception of stability (p-value = 0.0824).     

“肘关节稳定环”概念和重建原则的提出和临床意义

目的提出“肘关节稳定环”概念并在复杂肘关节骨折脱位治疗根据相应环的各个部分损伤进行重建,评价临床疗效。方法提出“肘关节稳定环”概念,将“肘关节稳定环”划分4个部分,并提出2个重建原则：“3／4”原则和“2个优先”原则。自2009－07—2012—07诊治20例复杂肘关节骨折脱位,包括肘关节恐怖三联征17例,经尺骨鹰嘴骨折脱位3例。手术重建目标为外侧环（外侧副韧带）、下侧环（又分为下外环桡骨头、下内环尺骨鹰嘴和近端冠状突骨折）,内侧环（内侧副韧带）未予手术干预。结果术后X线片未见内固定失败和松动,未见肘关节不稳,术后骨折均于术后4个月愈合．未见骨折不愈合。出现异位骨化2例,Mayo肘关节功能评分为54-95分,平均80分,其中优5例,良10例,可2例,差3例,优良率为75．0％。结论“肘关节稳定环”概念的提出及按照稳定环的各个部分进行有效地固定重建对于复杂肘关节损伤的重建具有一定的临床意义。     

Elbow capsulectomy for posttraumatic elbow stiffness

PURPOSE: To determine factors associated with diminished elbow function and upper-extremity-specific health status after elbow capsulectomy for posttraumatic stiffness. METHODS: Forty-six adult patients with posttraumatic elbow stiffness were evaluated an average of 48 months after open capsular excision. A second capsular excision was performed in 9 patients (29%). Stepwise multiple linear regression analysis was used to identify predictors of the American Shoulder and Elbow Surgeons Elbow Score, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder, and Hand scores after all procedures. RESULTS: The average improvement in ulnohumeral motion after the index surgery for capsular release was 53 degrees . (The average flexion was 98 degrees .) The 9 patients who had subsequent repeat elbow contracture release gained an additional 24 degrees , leading to a final average flexion arc for the entire cohort of 103 degrees . Multiple linear regression identified the American Shoulder and Elbow Surgeons pain score, persistent ulnar nerve dysfunction, and duration of follow-up evaluation after the initial capsular release as independent predictors of a higher Disabilities of the Arm, Shoulder, and Hand questionnaire score; flexion arc and pain score as independent predictors of the Mayo Elbow Performance Index; and flexion arc, forearm arc, pain score, and persistent ulnar neuropathy as independent predictors of the American Shoulder and Elbow Surgeons score. CONCLUSIONS: Open elbow capsulectomy for posttraumatic elbow stiffness restores a near-100 degrees flexion arc on average. Second elbow releases provide limited additional motion in most patients. Final motion influences physician-based rating scales but not patient-specific health status (Disabilities of the Arm, Shoulder, and Hand questionnaire), which is dominated by pain and persistent ulnar neuropathy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

The treatment and functional outcome of type IV coronal shear fractures of the distal humerus: a retrospective review of five cases

OBJECTIVE: To present the treatment method and outcome of 5 cases of type IV coronal shear fractures of the distal end of the humerus. DESIGN: Retrospective study. PATIENTS: Five patients with an isolated type IV coronal shear fracture of the distal end of the humerus. INTERVENTION: Open reduction and internal fixation of the fractures utilizing Herbert screws, through a modified extensile lateral Kocher approach. MAIN OUTCOME MEASUREMENTS: Functional elbow index rating scale of Broberg-Morrey, Mayo Elbow Performance Score, subjective satisfaction rate and subjective functional limitations, and radiographic evaluation of the operated elbows for the presence or absence of osteonecrosis and degenerative joint disease changes. RESULTS: The follow-up time ranged from 39 to 50 months. All fractures healed within 6 to 9 weeks. The latest radiographic evaluation revealed mild degenerative joint disease changes in 1 patient and osteonecrosis of the coronal shear fragment in another. None of the patients reported pain even during strenuous activities, and none had clinical findings or subjective complaints suggesting instability of the elbow joint. Four patients regained full range of elbow motion compared with the contralateral elbow, and only 1 had a 10 degrees extension lag. The muscle strength of the major muscle groups of the operated elbow was equal to that of the uninjured elbow when tested clinically. No patient reported limitations in activities, and all indicated complete satisfaction with their outcome. According to the Broberg-Morrey scale and the Mayo Elbow Performance Score, all results were excellent, with scores ranging from 98 to 100 points. CONCLUSIONS: Recognition of this particular type of injury, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes.