同側上腕骨骨折と肘頭粉砕骨折の合併損傷（floating elbow）の2例

Treatment of Concomitant Ipsilateral Fractures of the Humerus and Olecranon : Reports of Two Cases

　抄録：われわれは同側上腕骨骨幹部骨折と肘頭粉砕骨折を合併したfloating elbowの2症例を経験した．交通事故や高所からの転落など高エネルギー損傷が原因となるため，軟部組織損傷や他臓器損傷を合併する頻度が高く，受傷後早期に手術ができない場合が多い．そのため術前に十分な手術計画を行い，強固な固定と早期からのリハビリテーションが必要となる．われわれは肘頭粉砕骨折に対し，腸骨移植を用いたmultiple tension band wiringを行い強固な固定で正確な解剖学的形態を整復保持ができたことにより，術後早期からの肘関節訓練が可能となり，満足できる可動域を獲得することができた．

　The combination of ipsilateral fractures of the humerus and forearm is also described as ‘floating elbow.’ Such fractures are highly unstable and may have an intra-articular component. We encountered two cases of ‘floating elbow’ in which an ipsilateral fracture of the humerus was associated with a comminuted fracture of the olecranon. High-energy wounds are usually caused by falls from heights and traffic accidents. After sustaining the injury, the ‘floating elbow’ often cannot be immediately operated on because of the high frequency of associated injuries to soft tissue and other organ systems, making, it necessary to devise sufficient preoperative surgical strategies in order to restore precise anatomical alignment using rigid fixation so that early postoperative movement can be achieved. We treated two patients with ipsilateral humerus fractures by means of intramedullary nails or plates, and multiple tension band wiring and a graft from the iliac crest were used to treat comminuted fractures of the olecranon (Mayo type ⅡB and ⅢB). These operative techniques enabled satisfactory elbow joint exercise in the early postoperative period and resulted in an excellent functional outcome.