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Re: Ложный сустав локтевого отростка
послал Adonin 27 Октябрь 2010, 02:30
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про стабильность - удаленный внутренний надмыщелок нисколько не влияет на стабильность сустава. по данным McKeever and Buck 80 % олекранона может быть удалено без видимой дестабилизации сустава. полная цитата из того же кэмпбелла ( на этот раз глава"переломы", в пердыдущем посте - из главы " несрощения" )- ниже
Excision of a proximal fragment has several advantages. First, the possibility of nonunion is eliminated; only the triceps tendon must become anchored to the distal fragment. Second, the possibility of traumatic arthritis resulting from irregularity of the articular surface is minimized. This method can be used only if enough of the olecranon is left to form a stable base for the trochlea. It is not indicated if a comminuted fracture extends as far distally as the coronoid process. Even if used correctly, the method may be criticized because the elbow is less efficient without the proximal end of the ulna, and because the olecranon projection of the posterior aspect of the elbow joint is lost. McKeever and Buck introduced this form of treatment and recommended it for old ununited fractures, fractures that are extensively comminuted, fractures in the very elderly, and fractures not involving the trochlear notch. McKeever and Buck stated that 80% of the olecranon can be excised without appreciably affecting the stability of the elbow joint. MacAusland and Wyman also advocated excision of the olecranon if the fracture is an isolated injury; however, they noted that in the presence of any evidence of injury to the anterior bony or soft-tissue structures, excision of the olecranon is contraindicated for fear of producing elbow instability. They excised the entire olecranon if the coronoid and the anterior structures were undamaged. Gartsman et al. found that excision of even large fragments of the olecranon with repair of the triceps resulted in 20% fewer operative complications than open reduction and internal fixation techniques.
According to McKeever and Buck and MacAusland and Wyman, the elbow joint is stable enough as long as the coronoid process and the vertical distal face of the semilunar notch are preserved; a fragment that makes up 80% of the semilunar notch can be excised without ill effects. Because some of their patients noted that the ulnar nerve could be traumatized more easily after excision of the olecranon, they advised anterior transposition of the nerve at the time of excision of the olecranon.
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