Absorbable polyglycolide pins in fixation of displaced fractures of the radial head

Summary In a prospective study 24 patients with a displaced fracture of the radial head were treated by open reduction and internal fixation using absorbable polygly-colide pins, 2 mm in diameter. All patients admitted with fractures involving a quarter or more of the radial head, whether comminuted or not, were included in the study whenever there was a displacement of 2 mm or more between the fragments. The mean follow-up time was 28 months (range 15–43 months). A postoperative redisplacement of 1–3 mm between the fragments was seen in four patients with severely comminuted fractures. A transient inflammatory reaction around the implants occurred in two cases 8–12 weeks postoperatively. The functional end-result was classified as excellent or good in 22 patients (91%). This study indicated that successful fixation of displaced fractures of the radial head can be accomplished by using absorbable pins.     

可吸收自身增强软骨钉治疗桡骨小头骨折

 目的 评估可吸收自身增强软骨钉治疗桡骨小头骨折的临床疗效。方法 回顾性分析2008年1月至2011年12月采用切开复位、可吸收自身增强软骨钉固定治疗22例桡骨小头骨折患者资料,其中18例资料完整,男10例,女8例;年龄13~55岁,平均36.8岁;左侧10例,右侧8例。按Mason分型：Ⅱ型14例,Ⅲ型3例,Ⅳ型1例;其中2例合并桡骨颈骨折,9例合并肱骨小头软骨骨折,1例合并肘关节后脱位伴尺骨鹰嘴撕脱性骨折。术中对桡骨小头骨折复位后先以克氏针临时固定,再用直径为1.5 mm、长度为16~24 mm可吸收自身增强软骨钉固定,螺钉不穿过对侧骨皮质,螺钉头埋入软骨下;对同时存在的颈部骨折,先复位桡骨小头,以软骨钉固定,再复位颈部,用微型“T”形钢板或解剖型钢板固定。对合并肱骨小头骨软骨骨折,其中4例给予软骨片复位、可吸收缝线经肱骨外上髁固定,5例因骨软骨片较小无法固定而去除。结果 18例患者均获得随访,随访时间6~54个月,平均31.3个月;骨折均顺利愈合,愈合时间5~12周,平均8.7周。随访时无一例出现内固定失败、血肿、积液、窦道形成、桡骨小头溶骨性变化等并发症。Broberg-Morrey评分为68~100分,其中优13例,良4例,可1例,优良率为94.44％(17/18)。术后肘关节屈伸活动度为90°~150°,平均123.8°;前臂旋转活动度为130°～180°,平均152.5°。结论 可吸收自身增强软骨钉可治疗各种类型桡骨小头骨折,术后疗效满意。     

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。     

Newly defined fracture pattern specific to Mason III radial head fractures: fracture description, management and outcomes using screw fixation

Background: Radial head fractures are the most common type of elbow fracture and are universally classified under the Mason classification system. Mason type III fractures are comminuted and are the most difficult to treat, generally requiring plating if possible, or more commonly arthroplasty or excision, which gives a variable outcome. We hypothesized that a new and specific fracture pattern of the radial head (Mason III) can be treated successfully with screw fixation. Methods: Six patients presented to the senior surgeon's clinic with this unusual Mason III fracture pattern. In these patients, the fracture was acute, requiring an open reduction and internal fixation with the use of three headless compression screws. Average follow‐up time was 21 months. Using serial X‐rays and the Broberg–Morrey elbow score, the six acute fractures were evaluated radiologically and functionally. Results: All six patients had good to excellent results using the Broberg–Morrey scoring system. All patients showed radiological and clinical union within 3 months of injury. No patient required revision surgery or excision at a later date. Discussion: We have recognized a specific type of comminuted and displaced Mason III radial head fracture that has not previously been described in the literature. This type of fracture is amenable to open reduction internal fixation with buried compression screws giving a good to excellent outcome, while avoiding the common consequences seen with a radial head excision, arthroplasty or plate fixation.     

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.     

切开复位内固定治疗移位的桡骨头骨折

[目的]探讨切开复位内固定治疗成人移位桡骨头骨折的手术技术。[方法]本组移位桡骨头骨折26例,MasonⅡ型16例,Ⅲ型6例,Ⅳ型4例。22例用肘后外侧Kocher切口,另外4例用肘后正中切口以便同时处理合并的尺骨近端骨折。复位后用微型钢板螺钉固定,并使内固定物不妨碍关节活动。[结果]随访平均32个月,无骨间后神经损伤及感染发生,26例骨折均顺利愈合。按照Broberg和Morrey肘部评分标准,优17例,良9例。[结论]切开复位内固定治疗移位桡骨头骨折可取得满意疗效,术中应注意以下方面：（1）保护、修复尺骨外侧副韧带;（2）防止损伤骨间后神经;（3）努力达到解剖复位;（4）固定既要坚强可靠,又要不阻碍关节的运动。     

微型钛板内固定治疗复杂桡骨头骨折

目的探讨运用微型钛板治疗复杂桡骨头骨折的可行性及疗效。方法 21例复杂桡骨头骨折患者,采用手术切开复位、微型钛板内固定的方法治疗,其中MasonⅡ型14例,Ⅲ型7例。均采用肘关节后外侧切口,骨折复位后克氏针辅助固定,再行指骨钛板螺钉固定,确认关节面平整,关节旋转及伸屈运动无阻碍。术后予石膏外固定2～4周,石膏拆除后开始渐进的功能锻炼。结果本组手术时间50～80 min,平均（65±15）min。均获随访,平均随访时间14.5（5～24）个月,术后3～5个月骨折均获骨性愈合,肘关节屈平均115°（110°～125°）,伸平均5°（0°～10°）,旋前平均55°（50°～60°）,旋后平均50°（40°～60°）。1例遗留轻度肘关节疼痛;无肘关节外翻不稳定及创伤性关节炎发生。根据Broberg和Morrey评分评价肘关节功能：优8例,良10例,可3例,优良率85.7%。结论运用微型钛板固定桡骨头骨折安全可行,能更好地恢复桡骨头关节面的解剖结构,并有效固定,为早期肘关节功能锻炼提供了稳定性,有利于肘关节功能的恢复。     

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。     

Absorbable pins of self-reinforced poly-L-lactic acid for fixation of fractures and osteotomies.

We reviewed 27 patients with small-fragment fractures or osteotomies treated by internal fixation with absorbable self-reinforced poly-L-lactide pins. The follow-up time ranged from eight to 37 months. The two most common indications were chevron osteotomy of the first metatarsal bone for hallux valgus and displaced fracture of the radial head. No redisplacements occurred, and there were no signs of inflammatory foreign-body reaction. Biopsy in two patients 20 and 37 months after implantation showed that no polymeric material remained.     

Internal fixation of proximal radial head fractures

The treatment of choice for proximal radial head fractures remains controversial. The goal of any treatment for an intra-articular fracture must be the complete restoration of the joint and its function. Nonoperative treatment leads to full motion in cases of less than 1-2 mm of fracture displacement. Resection of the radial head can be recommended only for very comminuted fractures. All other fracture types should be treated by open reduction and internal fixation. Our own personal follow-up observation of 19 patients who had surgical intervention demonstrated restoration of elbow function after an average follow-up time of 11.7 months. Five patients had a slightly restricted range of motion of less than 10 degrees extension and flexion as well as less than 8 degrees pronation and supination, without signs of arthritis. Because complications were minimal, we recommend internal fixation of displaced proximal radial head fractures to restore the anatomic function of the elbow. This is especially true in cases with accompanying proximal ulna fractures and/or ruptured collateral ligaments of the elbow joint and/or disruption of the distal radio-ulnar joint.     

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.     

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。     

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.     

BOLD螺钉内固定治疗MasonⅡ型桡骨头骨折

目的 探讨采用BOLD螺钉分步延期（ORIF）治疗MasonⅡ型桡骨头骨折的方法 和临床疗效,为临床治疗此类骨折提供参考.方法 对16例MasonⅡ型桡骨头骨折采用BOLD螺钉行ORIF,术后石膏固定10 d,早期功能锻炼.按照Broberg和Morrey的评定标准对肘关节功能评分.结果 16例均获随访,随访时间12～53个月,平均23个月.肘关节功能评分为92.0～100.0分,平均为98.3分;其中优15例,良1例.结论 采用BOLD螺钉ORIF治疗MasonⅡ型桡骨头骨折,手术创伤小、功能恢复好,是治疗成人MasonⅡ型桡骨头骨折较好的方法.     

Open reduction and internal fixation of radial head fractures

Open reduction and internal fixation of displaced fractures of the radial head were reviewed in 14 elbows. Follow-up averaged 32 months. The average elbow score for Mason type II fractures was 96.8 points, corresponding to 100% good or excellent results. Average flexion was 142.5 degrees, and the mean fixed flexion deformity was 3.9 degrees. There was no loss in grip strength. An almost normal elbow was the expected result. Good or excellent results were achieved in only 33% of Mason type III fractures treated with open reduction and internal fixation. The average elbow score was 72.9 points, and this was statistically significantly different than the Mason type II fractures (p less than 0.05). An associated elbow dislocation did not affect the results significantly, but was associated with a slightly increased fixed flexion deformity. Fractures may be more comminuted than suggested by plain radiographs, and intraoperative decision making is required in deciding between reconstruction or excision of the radial head. Excellent results were obtained provided an anatomical reduction with stable fixation and early range of motion were achieved. If a stable anatomic reduction cannot be obtained, then alternative treatment methods should be considered.     

Biodegradable implants versus standard metal fixation for displaced radial head fractures. A prospective, randomized, multicenter study

This multicenter, prospective, randomized study compares the use of biodegradable polylactide pins with standard metal mini-fragment implants for the treatment of displaced radial head fractures. It compares complication rates and clinical outcomes of both treatment methods. At 2 years, 135 (82%) of 164 patients were available for evaluation. Equivalence of treatment method was defined as a difference of 10% or less in the number of complication-free patients. Functional status was assessed by using the Broberg and Morrey Elbow Score and compared by an unpaired t test. Good or excellent clinical results were achieved by 92% (56/61) of the control patients and 96% (71/74) of the polylactide patients. The incidence of complication-free patients was 3.7% less in the polylactide group than in the control group. The 1-sided 95% confidence interval for the treatment difference between the 2 groups was more than -6.1%. Biodegradable polylactide pins have at least comparable outcomes as standard metal implants for the internal fixation of reconstructable displaced radial head fractures.     

经肘前入路软骨钉治疗肱骨小头骨折

目的探讨经肘前人路软骨钉治疗肱骨小头骨折内固定手术的方法和疗效。方法 2008年6月至2011年8月,采用经肘关节前侧＂S＂形入路可吸收软骨钉内固定治疗肱骨小头骨折12例,男8例,女4例,年龄12～52岁,平均28.5岁,Ⅰ型骨折5例,Ⅱ型骨折3例,Ⅲ型2例,Ⅳ型2例;其中有3例合并有桡骨小头骨折,1例合并有尺骨冠状突骨折。结果随访6～36个月,平均25个月。骨折临床愈合时间4～10周,平均6周。根据Morrey肘关节功能评分标准,良好（满意）9例,一般3例,无骨不连及肱骨小头缺血性坏死发生。结论肘前人路损伤小,暴露清楚,可直视下对肱骨小头的骨折块进行解剖复位;可吸收软骨钉对关节软骨面的损伤小,固定牢靠,可早期进行功能锻炼,无需二次取出,有利于肘关节功能的良好恢复。     

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.     

肘关节“三联征”的诊治分析

目的:探讨肘关节"三联征"的诊疗要点及治疗效果。方法:回顾性分析2001年6月至2009年6月7例肘关节"三联征"的临床资料及随访结果。男6例,女1例;年龄20～68岁,平均36.5岁;均为新鲜骨折。全部病例住院后先行手法复位肘关节脱位,石膏固定,7～10d后手术治疗。均采用外侧切口入路,依次从深层至浅层修复冠状突骨折、前方关节囊、桡骨头骨折、外侧副韧带、伸肌总腱起点,冠状突骨折和桡骨头骨折复位后根据骨块大小采用不同方法固定。疗效按Mayo肘关节功能评分(Mayoelbowperformancescore,MEPS)评定。结果:本组平均随访16.3个月(5～36个月),骨折平均愈合时间4.5个月(3～6个月),异位骨化4例。肘关节活动度-20°～130°,平均106.5°;前臂旋转度70°～140°,平均121°。本组疗效优2例,良0例,一般4例,差1例。1例桡骨头切除,冠状突骨折复位后克氏针自后向前固定,术后拍X线片示冠状突骨折块发生分离移位,肘关节呈半脱位状态,随访时肘关节仍不稳定,关节功能差。结论:肘关节"三联征"应积极手术治疗,骨与软组织损伤并重处理,结合术后早期功能练习是获得良好疗效的关键。     

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.