Abstract：
BACKGROUND: The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon\'s outcomes using the Boyd approach for the treatment of simple to complex elbow injuries.
METHODS: Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics.
RESULTS: A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up.
CONCLUSIONS: This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.
METHODS: Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics.
RESULTS: A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up.
CONCLUSIONS: This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.
摘要：
背景：Boyd入路是一种单切口后入路，基于外侧解剖肌反射和外侧副韧带复合体的释放，到达桡骨和尺骨近端。这种方法仍然是一个较少利用的技术，在早期报道的近端桡骨滑脱和术后肘关节不稳定。虽然受到小案例系列的限制，最近的文献不支持这些早期报道的并发症.本研究提出了一位外科医生利用Boyd方法治疗简单至复杂肘关节损伤的结果。
方法：在机构审查委员会批准后，我们从2016年至2020年对肩肘外科医生使用Boyd入路连续治疗的所有简单至复杂肘部损伤患者进行了回顾性回顾.包括至少一次术后就诊的所有患者。收集的数据包括患者人口统计学，伤害描述,术后并发症,肘部运动范围,和影像学表现，包括异位骨化和近侧尺桡骨滑膜。使用描述性统计方法报告分类变量和连续变量。
结果：共纳入44例患者，平均年龄49岁（13-82岁）。最常治疗的损伤是Monteggia骨折脱位（32％）和可怕的三联伤（18％）。平均随访8个月(1-24个月)。最终平均肘部主动运动弧从20度（范围0-70度）的伸展度到124度（范围75-150度）的弯曲度。最终的旋后和内旋分别为53度（范围0-80度）和66度（范围0-90），分别。没有发生近端尺桡骨滑膜的病例。在选择保守治疗的两名（5％）患者中，异位骨化导致肘部ROM少于功能性。有1例（2％）由于受伤的韧带修复失败而导致术后早期后外侧不稳定，需要使用韧带增强程序进行翻修。5例（11%）患者术后出现神经病变，包括四个（9％）尺骨神经病。其中,一个人做了尺神经转位,两个正在改善，其中一人在最后一次随访时出现持续症状。
结论：这是最大的病例系列，证明了Boyd方法在治疗简单至复杂肘关节损伤中是安全的。术后并发症，包括滑膜和肘部不稳定可能不像以前理解的那样常见。
方法：在机构审查委员会批准后，我们从2016年至2020年对肩肘外科医生使用Boyd入路连续治疗的所有简单至复杂肘部损伤患者进行了回顾性回顾.包括至少一次术后就诊的所有患者。收集的数据包括患者人口统计学，伤害描述,术后并发症,肘部运动范围,和影像学表现，包括异位骨化和近侧尺桡骨滑膜。使用描述性统计方法报告分类变量和连续变量。
结果：共纳入44例患者，平均年龄49岁（13-82岁）。最常治疗的损伤是Monteggia骨折脱位（32％）和可怕的三联伤（18％）。平均随访8个月(1-24个月)。最终平均肘部主动运动弧从20度（范围0-70度）的伸展度到124度（范围75-150度）的弯曲度。最终的旋后和内旋分别为53度（范围0-80度）和66度（范围0-90），分别。没有发生近端尺桡骨滑膜的病例。在选择保守治疗的两名（5％）患者中，异位骨化导致肘部ROM少于功能性。有1例（2％）由于受伤的韧带修复失败而导致术后早期后外侧不稳定，需要使用韧带增强程序进行翻修。5例（11%）患者术后出现神经病变，包括四个（9％）尺骨神经病。其中,一个人做了尺神经转位,两个正在改善，其中一人在最后一次随访时出现持续症状。
结论：这是最大的病例系列，证明了Boyd方法在治疗简单至复杂肘关节损伤中是安全的。术后并发症，包括滑膜和肘部不稳定可能不像以前理解的那样常见。
