Abstract：
BACKGROUND: Although varus posteromedial rotatory instability (VPMRI) is a subtle elbow injury that involves anteromedial coronoid facet (AMCF) fracture and ligamentous injuries, treatment options and outcomes of VPMRI remains controversial. The aim of this study was to investigate radiographic findings, treatments, and outcomes of a large series of VPMRI.
METHODS: We retrospectively reviewed 91 pure VPMRI cases with AMCF fracture (O\'Driscoll classification anteromedial type) which were treated at 6 hospitals. Clinical and radiographic outcomes were investigated with a mean follow-up period of 46.8 months using the Mayo elbow performance score (MEPS), and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and serial plain radiographs.
RESULTS: In AMCF fracture, there were 4 cases of subtype 1, 67 cases of subtype 2, and 20 cases of subtype 3. On MRI, complete tears of lateral collateral ligament and medial collateral ligament were observed in 83.1 % (59/71 cases) and 33.8 % (24/71 cases). Operative treatment was performed in 68 cases (74.7 %) including both side fixation in 40 cases (58.8 %), medial side fixation only in 17 cases (25.0 %), and lateral side fixation only in 11 cases (16.2 %). Nonoperative treatment was performed in 23 cases (25.3 %). The mean final MEPS and Quick-DASH scores were 93.7 and 7.9. The overall complication and reoperation rates were 22.0 % and 15.4 %. No significant differences regarding final clinical scores and range of motions were observed between the operative group and the nonoperative group, but significant differences were observed regarding number (p = 0.019) and displacement (p = 0.002) of coronoid fragment, and complication rate (p < 0.001) between the two groups.
CONCLUSIONS: Depending on the pattern of coronoid fragment and the degree of ligamentous injuries, operative treatment of unstable VPMRI using various fixation techniques including coronoid fixation and ligament repair yielded satisfactory final clinical outcomes. However, surgeons should be aware of the high complication and reoperation rates after operative treatment. Stable VPMRI with AMCF fracture involving minimal displacement or small number of fragments can be treated nonoperatively.
METHODS: We retrospectively reviewed 91 pure VPMRI cases with AMCF fracture (O\'Driscoll classification anteromedial type) which were treated at 6 hospitals. Clinical and radiographic outcomes were investigated with a mean follow-up period of 46.8 months using the Mayo elbow performance score (MEPS), and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and serial plain radiographs.
RESULTS: In AMCF fracture, there were 4 cases of subtype 1, 67 cases of subtype 2, and 20 cases of subtype 3. On MRI, complete tears of lateral collateral ligament and medial collateral ligament were observed in 83.1 % (59/71 cases) and 33.8 % (24/71 cases). Operative treatment was performed in 68 cases (74.7 %) including both side fixation in 40 cases (58.8 %), medial side fixation only in 17 cases (25.0 %), and lateral side fixation only in 11 cases (16.2 %). Nonoperative treatment was performed in 23 cases (25.3 %). The mean final MEPS and Quick-DASH scores were 93.7 and 7.9. The overall complication and reoperation rates were 22.0 % and 15.4 %. No significant differences regarding final clinical scores and range of motions were observed between the operative group and the nonoperative group, but significant differences were observed regarding number (p = 0.019) and displacement (p = 0.002) of coronoid fragment, and complication rate (p < 0.001) between the two groups.
CONCLUSIONS: Depending on the pattern of coronoid fragment and the degree of ligamentous injuries, operative treatment of unstable VPMRI using various fixation techniques including coronoid fixation and ligament repair yielded satisfactory final clinical outcomes. However, surgeons should be aware of the high complication and reoperation rates after operative treatment. Stable VPMRI with AMCF fracture involving minimal displacement or small number of fragments can be treated nonoperatively.
摘要：
背景：尽管内翻后内侧旋转不稳定（VPMRI）是一种微妙的肘部损伤，涉及前内侧冠状关节突（AMCF）骨折和韧带损伤，VPMRI的治疗方案和结局仍存在争议.这项研究的目的是调查放射学结果，治疗,以及一系列VPMRI的结果。
方法：我们回顾性分析了在6家医院接受治疗的91例纯VPMRI伴AMCF骨折（O\'Driscoll分类前内型）。使用Mayo肘关节功能评分（MEPS），平均随访期为46.8个月，对临床和影像学结果进行了调查。和手臂的快速残疾，肩和手（快速DASH）得分，和连续的普通射线照片。
结果：在AMCF骨折中，1型4例，2型67例，3型20例。核磁共振成像,外侧副韧带和内侧副韧带完全撕裂率分别为83.1%(59/71例)和33.8%(24/71例)。手术治疗68例（74.7%），其中双侧固定40例（58.8%），仅内侧固定17例（25.0％），仅外侧固定11例(16.2%)。非手术治疗23例(25.3%)。平均最终MEPS和Quick-DASH得分分别为93.7和7.9。总并发症和再手术率分别为22.0%和15.4%。手术组和非手术组的最终临床评分和运动范围无显著差异。但观察到关于冠状骨碎片的数量（p=0.019）和位移（p=0.002）的显着差异，两组并发症发生率(p<0.001)。
结论：根据冠状骨碎片的形态和韧带损伤的程度，使用包括冠状突固定和韧带修复在内的各种固定技术对不稳定的VPMRI进行手术治疗,取得了令人满意的最终临床结果.然而,外科医生应意识到手术治疗后的高并发症和再手术率。稳定的VPMRI伴AMCF骨折，位移最小或碎片数量少，可以非手术治疗。
方法：我们回顾性分析了在6家医院接受治疗的91例纯VPMRI伴AMCF骨折（O\'Driscoll分类前内型）。使用Mayo肘关节功能评分（MEPS），平均随访期为46.8个月，对临床和影像学结果进行了调查。和手臂的快速残疾，肩和手（快速DASH）得分，和连续的普通射线照片。
结果：在AMCF骨折中，1型4例，2型67例，3型20例。核磁共振成像,外侧副韧带和内侧副韧带完全撕裂率分别为83.1%(59/71例)和33.8%(24/71例)。手术治疗68例（74.7%），其中双侧固定40例（58.8%），仅内侧固定17例（25.0％），仅外侧固定11例(16.2%)。非手术治疗23例(25.3%)。平均最终MEPS和Quick-DASH得分分别为93.7和7.9。总并发症和再手术率分别为22.0%和15.4%。手术组和非手术组的最终临床评分和运动范围无显著差异。但观察到关于冠状骨碎片的数量（p=0.019）和位移（p=0.002）的显着差异，两组并发症发生率(p<0.001)。
结论：根据冠状骨碎片的形态和韧带损伤的程度，使用包括冠状突固定和韧带修复在内的各种固定技术对不稳定的VPMRI进行手术治疗,取得了令人满意的最终临床结果.然而,外科医生应意识到手术治疗后的高并发症和再手术率。稳定的VPMRI伴AMCF骨折，位移最小或碎片数量少，可以非手术治疗。
