Indikation und Ergebnisse nach Radiuskopfprothesen

Treatment of unreconstructible comminuted fractures of the radial head (Mason type III or IV) remains controversial. Radial head excision was advocated for the management of these severe fractures in the past. Complications such as valgus elbow instability, elbow stiffness, and proximal radial migration can be the result. There is limited information on the outcome of arthroplasty with a radial head implant. The functional outcomes of 19 patients with arthroplasty of the radial head were evaluated after an average of 40.4 months. According to the functional rating index (Broberg and Morrey), 2 results were graded as poor, 6 as fair, and 11 as good or excellent. The poor and fair outcomes were associated with concomitant injuries. Elbow flexion of the injured extremity averaged 121±15°, extension ?19±12°, pronation 76±17°, and supination 73±18°. Valgus stability was restored and proximal radial migration did not occur. Complications included two luxations, but no wound infection. Patients treated with radial head prosthesis for a severely comminuted radial head fracture have mild to moderate impairment of the elbow and wrist. Arthroplasty with a radial head prosthesis was found to have been a safe and effective treatment option.     

Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation

PURPOSE: The purpose of this study was to evaluate the treatment of patients with Mason type III radial head fracture with and without elbow dislocation by open reduction with internal fixation, collateral ligament repair, and early mobilization. An additional purpose was to investigate whether there is any effect of elbow dislocation on the severity and functional outcome. METHODS: Twenty-five patients were treated with open reduction with internal fixation using low-profile miniplate and screws for comminuted fracture of the radial head. Eighteen fractures were Mason type III, and 7 fractures were Mason type III with elbow dislocation. There were 5 women and 20 men with a mean age of 34 years. The mean follow-up time was 27 months. Patients were reviewed for functional ability, physical examination, and radiographic assessment. RESULTS: The mean functional index in Mason type III fracture and Mason type III fracture with elbow dislocation was 87 for both groups. The mean range of motion at the elbow joint was calculated as 5 degrees extension to 136 degrees flexion for Mason type III and 7 degrees extension to 133 degrees flexion for Mason type III with elbow dislocation. The mean pronation and supination for all patients were 74 degrees and 67 degrees , respectively. CONCLUSIONS: Selected Mason III radial head fractures and fracture dislocations could be stabilized satisfactorily with internal fixation. Meticulous surgical technique, combined with rigid internal fixation, can allow early motion of the forearm and elbow after fixation of Mason type III radial head fractures with and without elbow dislocation and ligamentous injury. We believe there is still a role for prosthetic replacement in comminuted Mason III radial head fractures that cannot reliably be treated with open reduction and internal fixation. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.     

Open reduction and internal fixation of fractures of the radial head

BACKGROUND: The purpose of this retrospective study was to analyze the functional results following open reduction and internal fixation of fractures of the radial head and to determine which fracture patterns are most amenable to this treatment. METHODS: Fifty-six patients in whom an intra-articular fracture of the radial head had been treated with open reduction and internal fixation were evaluated at an average of forty-eight months after injury. Thirty patients had a Mason Type-2 (partial articular) fracture, and twenty-six had a Mason Type-3 (complete articular) fracture. Twenty-seven of the fifty-six fractures were associated with a fracture-dislocation of the forearm or elbow or an injury of the medial collateral ligament. Fifteen of the thirty Type-2 fractures were comminuted. Fourteen of the twenty-six Type-3 fractures consisted of more than three fragments, and twelve consisted of two or three fragments. The result at the final evaluation was judged to be unsatisfactory when there was early failure of fixation or nonunion requiring a second operation to excise the radial head, <100 degrees of forearm rotation, or a fair or poor rating according to the system of Broberg and Morrey. RESULTS: The result was unsatisfactory for four of the fifteen patients with a comminuted Mason Type-2 fracture of the radial head; all four fractures had been associated with a fracture-dislocation of the forearm or elbow, and all four patients recovered <100 degrees of forearm rotation. Thirteen of the fourteen patients with a Mason Type-3 comminuted fracture with more than three articular fragments had an unsatisfactory result. In contrast, all fifteen patients with an isolated, noncomminuted Type-2 fracture had a satisfactory result. Of the twelve patients with a Type-3 fracture that split the radial head into two or three simple fragments, none had early failure, one had nonunion, and all had an arc of forearm rotation of > or =100 degrees. CONCLUSIONS: Although current implants and techniques for internal fixation of small articular fractures have made it possible to repair most fractures of the radial head, our data suggest that open reduction and internal fixation is best reserved for minimally comminuted fractures with three or fewer articular fragments. Associated fracture-dislocation of the elbow or forearm may also compromise the long-term result of radial head repair, especially with regard to restoration of forearm rotation.     

A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III

Although several treatment options for radial head fractures are available, no clear solutions exist. In this study we therefore compare open reduction and internal fixation (ORIF) with bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason type III. Cement stem and bipolar radial prosthesis were used to treat 12 fresh cases and two old cases of Mason type III radial head fracture. As a control group, another eight cases of radial head type III fracture were treated with ORIF with cannulated screws and Kirschner (K) wires. The 14 patients who received radial head prosthesis replacement were followed-up for 15.9 months (range 10-27 months). According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four, and fair in one. Mean follow-up of the eight cases in the ORIF group was 14 months (range 10-21 months), with good results in one case, fair in four, and poor in three. The result was good or excellent in 92.9% of prosthesis replacement patients and in 12.5% of ORIF patients. This difference is statistically significant (P = 0.0004; Fisher's exact test). We concluded that bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type III radial head fracture.     

Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates

Between 1996 and 2000, we treated ten patients with severely comminuted fractures of the radial head using low-profile mini-plates. Their mean age was 42 years (24 to 71). Three fractures were Mason type III and seven were Mason-Johnston type IV. At a mean follow-up of 28.5 months (15 to 44), all fractures had united. The plates were removed in nine patients. No patient had difficulty with daily activities or symptoms of instability of the elbow. The mean range of flexion of the elbow was from 7 degrees to 135 degrees, with 74 degrees of supination and 85 degrees of pronation. According to the Broberg and Morrey functional elbow index, the mean score was 90.7 points (73 to 100), and the outcome was excellent in three patients, good in six and fair in one. These results compare favourably with those reported previously. The technique is applicable to severely comminuted fractures of the radial head which otherwise would require excision.     

桡骨头置换术治疗桡骨头严重粉碎性骨折

目的探讨桡骨头置换术治疗桡骨头严重粉碎性骨折的疗效。方法 2006年6月至2009年2月行桡骨头置换术治疗6例桡骨头严重粉碎性骨折患者,男4例,女2例;年龄24～36岁,平均27.6岁;均为MasonⅢ型、Ⅳ型。结果术后6例患者全部获得随访,随访时间为4～36个月,平均27个月。除1例患者活动时外侧有摩擦感、轻度疼痛外,其余患者均恢复良好。按Broberg-Morrey评分标准进行综合评定,优4例,良1例,可1例,差0例,平均93.8分,患者满意度为100%。结论人工桡骨头置换术能够恢复肘关节的稳定性及活动度,是治疗桡骨头粉碎性骨折的一种良好术式。     

手术治疗桡骨头前侧塌陷骨折

目的：探讨手术治疗桡骨头前侧塌陷骨折的临床疗效.方法：2006年3月至2013年1月收治17例桡骨头前侧塌陷骨折的患者,根据Mason分型,Ⅱ型12例,Ⅲ型5例.采用肘关节后外侧入路进行切开复位,并用Herbert钉或钛空心钉进行内固定.结果：术后均获随访,时间6～18个月,平均11.3个月.根据Broberg和Money肘关节功能评分标准评定：优2例,良12例,可3例.术后未发生肘部感染、神经损伤、骨不连、创伤性关节炎、异位骨化以及肘关节不稳定.但术后患侧肘关节活动范围小于健侧.结论：桡骨头前侧塌陷骨折容易漏诊,可以通过肘关节后外侧入路进行切开复位内固定.     

可吸收钉棒治疗粉碎性桡骨头骨折

目的探讨可吸收钉棒治疗粉碎性桡骨头骨折的疗效。方法对21例MasonⅢ、Ⅳ型桡骨头骨折患者施行切开复位可吸收钉棒内固定。结果 21例均获随访,时间5～35（20.5±9.6）个月,按B roberg和Morrey的肘部评分标准评判：优6例,良13例,可2例。结论可吸收钉棒治疗粉碎性桡骨头骨折操作简便,疗效确切,不需二次手术,具有临床优势。     

On-table reconstruction and fixation of Mason type III radial head fractures

Purpose: To evaluate the functional and radiological outcome of comminuted radial head fractures, which were not amenable for classical open reduction with internal fixation, treated by on-table reconstruction and fixation using low profile plates. Methods: We reviewed 6 patients of Mason type III radial head fractures treated by on-table reconstruction technique between 2011 and 2013. There were 5 men and 1 woman with a mean age of 35 years (range 25-46 years). All surgeries were carried out at our tertiary care level 1 trauma centre within a mean of 3 days (range 1-8 days) from date of injury using on-table reconstruction technique. The functional outcome was measured using elbow functional rating index described by Broberg and Morrey and the patient-based Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Results: The mean follow-up period was 25 months. The average elbow flexion was 135 (range 125°-140°) and the average flexion contracture was 5 (range 0-10°). The average supination and pronation was 75 (range 70°-80°) and 70 (range 65°-82°) respectively. According to Broberg and Morrey scoring system, the average score was 90 points (range 75-100). The mean DASH score was 2.49 points. Conclusion: On-table reconstruction and fixation of comminuted radial head fractures using low profile plates is a reasonable option. The reconstructed radial head acts as spacer and provides reasonably good results and no surgical intervention is required for asymptomatic nonunion of these fractures regardless of the radiological findings.     

On-table reconstruction of comminuted fractures of the radial head

The most widely accepted treatment for comminuted fractures of the radial head is either the excision or open reduction and internal fixation. The purpose of the present study is to evaluate the value of an ‘on-table’ reconstruction technique in severely comminuted fractures of the radial head. In this study, two patients with a Mason type-III and four patients with a Mason type-IV radial-head fracture were treated with ‘on-table’ reconstruction and fixation using low-profile mini-plates. After a mean follow-up of 112 months (47-154 months), the mean elbow motion was 0-6-141° extension flexion with 79° of pronation and 70° of supination. The mean Broberg and Morrey functional rating score was 97.0 points, the Mayo Elbow Performance Index was 99.2 points and the mean Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure score was 1.94 points. One patient had symptoms of degenerative changes, with a slight joint-space narrowing. There were no radiographic signs of devitalisation at final examination. Comminuted fractures of the radial head, which would otherwise require excision, can be successfully treated with an ‘on-table’ reconstruction technique.     

Offene Rekonstruktion von Radiusköpfchenfrakturen mit und ohne begleitende Bandinstabilität

Background

The treatment of fractures of the radial head is commonly based on the Mason classification. Fractures of the radial head caused by a dislocation of the elbow are summarized as Mason type IV fractures. The purpose of this study was to investigate the outcome and the influence of additional ligamentous injuries after reconstruction of fractures of the radial head.

Patients and methods

One hundred three patients with a fracture of the radial head were treated by open reduction and internal fixation between 2004 and 2009. Fifty-eight of them could be evaluated at an average of 3.6 years after surgery. Forty-one patients had no additional ligamentous injury and 17 had a fracture combined with complete dislocation of the elbow. At the final follow-up examination, all patients were assessed clinically, bilateral radiographs were taken, and the Broberg and Morrey and Kellgren & Lawrence scores were determined.

Results

Ten patients had a Mason type II, 31 a Mason type III and 17 a Mason type IV fracture. With regard to the Broberg and Morrey score, patients without ligamentous injury achieved a significantly better functional outcome, with good to excellent results in 97.5% of cases compared to 64.6% for patients with ligamentous injuries. Twelve percent of the patients without ligamentous injury and 47% of the patients with ligamentous injuries developed moderate or severe posttraumatic arthritis. Heterotopic ossification was found in 19.5% of the patients without and in 47% of those with ligamentous injury.

Conclusion

Reconstruction of radial head fractures without ligamentous instability led to significantly superior functional results and lower rates of posttraumatic arthritis and heterotopic ossifications than osteosynthesis of fractures with additional ligamentous injury. In these cases primary endoprosthetic replacement might be considered.     

内固定术治疗Mason Ⅱ-Ⅳ型桡骨头骨折疗效分析

目的探讨内固定术治疗MasonⅡ-Ⅳ型桡骨头骨折的临床疗效。方法 2002年3月～2012年6月采用内固定术治疗桡骨头骨折患者41例,其中MasonⅡ型18例,Ⅲ型17例,Ⅳ型6例;开放性骨折Gustilo分型Ⅱ和ⅢA各1例。合并他处多发性骨折9例。伤后至手术时间平均6.7 d(3 h～30 d)。采用克氏针固定8例,螺钉固定11例,微型钢板固定15例,可吸收螺钉固定7例。结果本组41例均获随访,平均时间10(4～28)个月;骨折均愈合。按照Broberg和Morrey肘部评分标准判定疗效:优22例,良12例,可4例,差3例,优良率为82.9%(34/41)。2例儿童患者发生克氏针滑脱至皮下,骨折愈合后立即取出克氏针。结论内固定术能够改善MasonⅡ-Ⅳ型桡骨头骨折患者的肘关节功能;骨折端解剖复位、牢固内固定效果、良好修复关节的稳定性、早期功能锻炼能使患者获得良好的疗效。     

Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1-4 years

BACKGROUND: Treatment options in radial head fractures of Mason types III and IV range from open reduction and internal fixation (ORIF) to radial head resection with or without prosthetic replacement. PATIENTS: In a prospective study, the radiographic and clinical outcome was evaluated in 23 patients (age median 51 years) with 23 complex radial head fractures median 2 (1-4) years after ORIF using a new fixation device (FFS; Orthofix). 14 Mason type-III fractures with 2 concomitant olecranon fractures and 1 ulnar nerve lesion, and 11 type-IV fractures with 2 olecranon fractures and 2 fractures of the coronoid process were treated. 2 patients were lost to follow-up. In 7 cases of joint instability, an elbow fixator with motion capacity was applied after ORIF of the radial head. RESULTS: No radial head resection was necessary. No secondary dislocations or nonunion occurred. The Morrey elbow score was excellent in 8 and good in 4 Mason type-III fractures and excellent in 5, good in 3, and fair in 3 Mason type-IV fractures. INTERPRETATION: Reconstruction of comminuted radial head fractures can be performed with this device and radial head resection can be avoided.     

Therapeutic Effect of Resection,Prosthetic Replacement and Open Reduction and Internal Fixation for the Treatment of Mason Type III Radial Head Fracture

Abstract

Aim of the Study: Mason type III radial head fractures are a source of concern due to the severe injury and poor recovery. At present, radial head resection, open reduction and internal fixation (ORIF), and prosthetic replacement are three common treatment methods for these fractures. The clinical efficacy and postoperative complications are controversial, which makes it difficult for physicians to determine the most appropriate regimen. Herein, this present prospective, non-randomized, parallel-controlled study was conducted to compare the therapeutic effects and identify the most effective treatment method for Mason type III radial head fracture. Materials and Methods: We assessed patients with Mason type III radial head fracture treated with resection, prosthetic replacement, and ORIF to compare preoperative and postoperative pain condition, elbow joint function, curative effect, and complication rate. A visual analog scale was used to score pain. The elbow joint function was observed using the Broberg–Morrey elbow joint score. Results: No significant differences were found in patient demographics among the resection, prosthetic replacement, and ORIF groups. The prosthetic replacement and ORIF procedures were more complex and had higher technical requirements. Prosthetic replacement and ORIF enabled higher elbow joint scores and lower pain scores than resection. Excellent and good ratings were highest and complication rates were lowest in the prosthetic replacement group, followed by the ORIF group. Conclusion: Our results showed that prosthetic replacement is more effective than ORIF and radial head resection in relieving pain, functional recovery and reducing complications in the treatment of Mason type III radial head fractures.     

Therapie der Radiusköpfchenfraktur

The treatment of radial head fractures is challenging for the trauma surgeon due to the complex functional anatomy of the elbow. Satisfactory results can only be achieved if the function and stability of the humeroradial joint are entirely restored. Thus, depending on the fracture type, ranging from non-displaced Mason type I fractures to comminuted Mason type III fractures, an individual treatment concept has to be established. Treatment protocols range from conservative treatment with short-term cast immobilization to open reduction and internal fixation according to AO-principles or to the implantation of a radial head prosthesis. In case of severe comminution of the radial head, resection arthroplasty might be indicated.     

Therapy for radial head fractures

The treatment of radial head fractures is challenging for the trauma surgeon due to the complex functional anatomy of the elbow. Satisfactory results can only be achieved if the function and stability of the humeroradial joint are entirely restored. Thus, depending on the fracture type, ranging from non-displaced Mason type I fractures to comminuted Mason type III fractures, an individual treatment concept has to be established. Treatment protocols range from conservative treatment with short-term cast immobilization to open reduction and internal fixation according to AO-principles or to the implantation of a radial head prosthesis. In case of severe comminution of the radial head, resection arthroplasty might be indicated.     

Bold螺钉治疗MasonⅡ型桡骨小头骨折

目的探讨Bold螺钉内固定治疗Mason型桡骨小头骨折的临床疗效。方法自2006年5月至2009年6月,采用Bold螺钉内固定治疗Mason型桡骨小头骨折13例,男8例,女5例,年龄19～56岁,平均37.3岁。术后2d进行功能锻炼。术后定期X线复查,采用Broberg和Morrey肘关节功能评分标准评判疗效。结果所有患者均获得6～14个月随访,平均10个月。肘关节功能评分平均97分,优9例,良3例,差1例,优良率为92.3%。结论 Bold螺钉内固定治疗Mason型桡骨小头骨折,能精确重建关节面,早期功能锻炼,有助于恢复良好的肘关节功能,是一种治疗桡骨小头骨折的理想方法。     

Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis

Purpose

Open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) are the most common operative treatments in patients with radial head fractures. The purpose of this study was to determine the efficacy of RHA and ORIF treatments in patients with radial head fractures (modified Mason type III and IV).

Methods

We conducted a computerized search of five electronic databases from their inception to July 2015. All clinical trials comparing ORIF versus RHA treatment in patients with radial head fractures were included. We evaluated the primary outcomes included elbow functional evaluation criteria by Broberg and Morrey, elbow score (Broberg and Morrey), Mayo Elbow Performance Score (MEPS) and QuickDASH score. Secondary outcomes included Visual Analog Scale (VAS), range of motion, operation time and complications. The “assessing risk of bias” table was applied to assess the risk of bias of the included studies.

Result

Eight studies were included in this meta-analysis, which consisted of 138 cases of ORIF and 181 RHA. Methodological quality of the studies was moderate to low. RHA afforded significantly higher satisfaction rate, better elbow score (Broberg and Morrey) and MEPS, shorter operation time, lower incidence of bone nonunion or absorption and internal fixation failure when compared to ORIF. There were no significantly differences in QuickDASH score and other complications.

Conclusions

RHA has better outcome in patients with radial head fractures (modified Mason type III and IV) than ORIF with medium-short-term follow-up period, but longer-term studies will be required to ascertain whether the apparent benefits of RHA were offset by late complications.

Level of evidence

Therapeutic decision analysis; a meta-analysis, Level III.

     

Treatment of displaced radial head fractures by internal fixation with absorbable pins

Objective: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures. Methods: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason typesⅡandⅢ) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey. Results:All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15°(0°-35°), and pronation and supination decreased by 10°(0°-30°) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey. Conclusions: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.     

克氏针与微型钢板治疗MasonⅡ型及Ⅲ型桡骨头骨折的病例对照研究

目的:比较克氏针与微型钢板治疗MasonⅡ、Ⅲ型桡骨头骨折疗效。方法:2004年5月至2010年3月收治MasonⅡ、Ⅲ型桡骨头骨折共50例,其中使用克氏针治疗23例,微型钢板治疗27例。克氏针治疗组中男13例,女10例;平均年龄(42.5±0.7)岁;MasonⅡ型骨折14例,Ⅲ型骨折9例。微型钢板组中男17例,女10例;平均年龄(41.7±0.5)岁;MasonⅡ型骨折16例,Ⅲ型骨折11例。按照Broberg和Morrey的肘关节功能评分标准进行评分,比较两组患者异位骨化情况及临床疗效。结果:所有患者获随访,时间12～24个月,平均(16.5±1.3)个月,根据疗效评定标准,微型钢板组平均(90.5±11.6)分,克氏针组平均(70.6±11.3)分。微型钢板组优15例,良9例,一般2例,差1例;克氏针组优8例,良9例,一般3例,差3例。微型钢板组疗效优于克氏针组。而两组患者异位骨化发生率比较差异无统计学意义。结论:微型钢板治疗桡骨头骨折安全有效,疗效优于克氏针。