Stress fracture of the olecranon in an adult baseball player

Stress fractures of the olecranon caused by repetitive stress force have infrequently been reported as a cause of elbow pain in adult athletes, engaged in throwing and pitching sports. We diagnosed as a stress fracture of the olecranon by clinical and radiographic findings and treated surgically. The patient returned to playing baseball at a competitive level and was asymptomatic 4 months after the first operation. However, the patient re-injured the olecranon and a second surgical treatment was performed almost 1 year after the first operation. After the second surgery, the patient returned to playing baseball at a competitive level and was free from elbow symptoms. We presented a stress fracture of the olecranon in a semi-professional adult baseball player and suggested that surgical treatment is necessary.     

Bone and joint disorders in the upper extremities of chipping and grinding operators

Summary X-ray examinations of the wrists, the elbows and the shoulders were carried out on 67 vibration-exposed foundry workers and on 46 comparable referents performing heavy manual work. Both groups had a mean age of 39.6 years. Musculoskeletal symptoms, such as arthralgias of the wrist and elbow joints, muscle pain and decreased muscular force, were found to be significantly increased in the chipping and grinding workers compared with the referents. After adjustment for age, the prevalence of cysts in the metacarpal and carpal bones was almost the same in the two groups, whereas radiological signs of osteoarthritis in the wrist joint were more frequent among the vibration-exposed workers (P < 0.025). The overall prevalence of radiographic abnormalities in the elbow joint was higher in the vibration group than in the reference group (P < 0.025). Olecranon spurs were observed in 50.7% of the exposed operators and in 28.2% of the referents (P < 0.025). No difference in the prevalence of radiological changes in the shoulder could be demonstrated between the populations studied. In both groups injuries of bones and joints were not associated with age. Among the chipping and grinding operators, a slight but not significant trend in the prevalence of skeletal abnormalities with increasing vibration exposure was observed. The results of this study indicate that the foundry workers using vibrating tools were affected with bone and joint disorders in the elbow and, to a lesser extent, in the wrist, which occurred more frequently than was observed in unexposed referents, who performed solely heavy manual activity. Among the vibration-exposed workers, no relationship between radiological changes in the upper limbs and symptoms of vibration white finger was found, pointing out that different pathogenic mechanisms are involved.     

尺骨上段合并鹰嘴骨折内固定的生物力学研究

目的比较克氏针张力带、重建钢板联合张力带及鹰嘴解剖钢板固定尺骨上段合并鹰嘴骨折3种方式的生物力学稳定性,为临床选择内固定提供理论依据。方法 8个自愿捐献的新鲜成人尸体肘关节标本,均为男性;年龄26～43岁,平均34.8岁。于尺骨上段及尺骨鹰嘴分别截骨制作尺骨上段合并鹰嘴骨折模型。每个标本分别采用克氏针张力带(A组)、重建钢板联合张力带(B组)及鹰嘴解剖钢板(C组)3种方式对骨折端固定。采用生物力学测试系统进行单轴压缩试验,记录载荷-位移曲线,内固定系统的稳定性采用骨折端压缩位移为2 mm时所加的载荷值进行评价。结果实验过程中未出现克氏针退出、钢板螺钉断裂、标本破坏,标本与夹具固定无松动。3组标本均表现为位移随载荷增加而逐渐增长,但B、C组的载荷-位移曲线斜率明显高于A组。当骨折端压缩位移为2 mm时,A、B、C组的所加载荷值分别为(218.6±66.9)、(560.3±116.1)、(577.2±137.6)N,B、C组所加载荷值均显著高于A组,差异有统计学意义(P<0.05);B、C组间差异无统计学意义(t=0.305,P=0.763)。结论尺骨上段合并鹰嘴骨折多为不稳定骨折,重建钢板联合张力带、鹰嘴解剖钢板固定均能满足要求,临床上可根据患者情况合理选用。克氏针张力带固定不够牢固,临床上应避免单独使用。     

Tension band wiring for olecranon fractures

Surgical Principles Anatomical reduction of fragments and internal fixation with 2 Kirschner wires and a tension band wire stable enough to allow early exercises. This technique permits dynamic compression of fragments and a speedy consolidation of the fractures.     

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report

Introduction: Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. Materials and methods: We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. Results: After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. Conclusion: Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.     

经鹰嘴截骨双钢板内固定治疗C3型肱骨远端骨折

目的探讨肱骨远端C3型骨折的入路选择及内固定钢板的放置方法。方法选择2004年1月至2010年11月我院收治的肱骨远端骨折患者56例,其中C3型骨折32例,全部采用经鹰嘴截骨显露肱骨远端,肱骨内外侧解剖钢板90°放置内固定的手术治疗。所有病例均随访9～15个月,平均11.3个月。结果 32例患者切口均一期愈合,所有骨折骨性愈合,无内固定松动及退针出现;未出现骨化性肌炎;按改良Broberg和Morrey评分系统,优18例,良9例,可4例,差1例,优良率为84.4%。结论经鹰嘴截骨、90°双钢板内固定治疗C3型骨折,具有暴露充分、直视下良好整复关节面、内固定坚强可靠的优点,能满足早期功能锻炼的要求,符合国际内固定研究协会关节内骨折的治疗原则,是一种治疗复杂性肱骨远端骨折的可靠方法。     

老年肱骨髁间骨折经尺骨鹰嘴截骨手术治疗和保守治疗的疗效比较

目的探讨老年患者肱骨髁间骨折经尺骨鹰嘴截骨手术内固定的疗效,并与行保守治疗的老年患者进行比较.方法对2006年7月至2009年7月收治的34例老年肱骨髁间骨折进行回顾性分析,男17例,女20例,年龄60～79岁,平均68.2岁.Riseborough分型,Ⅰ型6例,Ⅱ型11例,Ⅲ型12例,Ⅳ型5例.其中,22例经尺骨鹰嘴截骨行双侧钢板固定治疗,其余患者拒绝手术或不能耐受麻醉,6例在臂丛麻醉下手法复位石膏夹板固定,6例以石膏夹板固定前臂吊带悬吊制动但未行手法复位.术后功能采取Mayo肘关节评分（MEPS）、上肢肩手功能障碍评分（DASH）进行评价.结果所有患者平均随访25.7月,最短12.6月,最长35.8月.手术病例22例,Ⅰ型2例,Ⅱ型6例,Ⅲ型10例,Ⅳ型4例,Mayo评分为50～94分,平均77.23分,优5例,良10例,可3例,优良率为68.2%.DASH评分值为24.7分.保守病例12例,Ⅰ型4例,Ⅱ型5例,Ⅲ型2例,Ⅳ型1例,Mayo评分为40～90分,平均65.58分,优1例,良4例,可2例,优良率为45.4%.DASH评分值为46.6分.并发症包括3例肱骨髁上延迟愈合,1例鹰嘴骨不连,2例严重的肘关节僵硬,1例内固定失效,2例尺神经麻痹.两组Mayo评分及DASH评分比较差异有统计学意义.结论经尺骨鹰嘴截骨双钢板内固定治疗老年肱骨髁间骨折比保守治疗获得较好的关节功能恢复,但手术治疗在老年患者严重骨质疏松且骨折粉碎严重时需要慎重.