Fractures of the radial head and neck treated with radial head excision

BACKGROUND: The reported long-term outcomes of the treatment of radial head and neck fractures with excision of the radial head have been mixed. The purpose of the present study was to evaluate the long-term outcomes of primary or delayed radial head excision for the treatment of these fractures. METHODS: Sixty-one individuals (mean age, forty-four years) with thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV fractures were evaluated subjectively, objectively, and radiographically at a mean of eighteen years (range, eleven to thirty-three years) after treatment. Forty-three fractures were treated with primary radial head excision, and the remaining eighteen were treated with delayed radial head excision at a median of five months (range, one to 238 months) after the injury. RESULTS: At the time of follow-up, twenty-eight individuals had no symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four individuals with daily pain had had a Mason type-IV fracture. The range of motion of the formerly injured upper extremities was slightly less than that of the uninjured upper extremities in terms of flexion (139 degrees +/- 11 degrees compared with 142 degrees +/- 8 degrees ), extension (-7 degrees +/- 12 degrees compared with -1 degrees +/- 6 degrees ), and supination (77 degrees +/- 20 degrees compared with 85 degrees +/- 10 degrees ) (all p < 0.01). A higher percentage of formerly injured elbows than uninjured elbows had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001), but none had a reduced joint space. No differences were found between the outcomes for individuals treated with a primary radial head excision and those for individuals treated with a delayed excision. CONCLUSIONS: Following a displaced radial head or neck fracture, excision of the radial head often leads to a good or fair result. We found no differences in outcome between primary and delayed radial head excisions following a Mason type-II, III, or IV fracture. The outcomes are associated with the type of fracture, with Mason type-IV fractures having the worst results, rather than with the timing of the radial head excision (primary or delayed).     

Results of acute excision of the radial head in elbow radial head fracture-dislocations

OBJECTIVES: To evaluate the results of radial head excision for the treatment of elbow fracture-dislocations with an unsalvageable comminuted radial head fracture and no other associated fractures. DESIGN: Retrospective study. SETTING: University Hospital. PATIENTS AND INTERVENTION: Ten elbow fracture-dislocations with a comminuted radial head fracture treated with radial head excision in our institution between 1990 and 1996 and followed a mean of 4.62 years. MAIN OUTCOME MEASUREMENTS: Clinical results were graded using the Mayo index and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiographs were evaluated for proximal radius migration, elbow angulation, degenerative changes, and ectopic bone. RESULTS: Final clinical results were excellent in four patients, good in five patients, and fair in one patient. Pain was absent in six patients, mild in three patients, and moderate in one patient. Mean flexion arc was 7.5 to 140 degrees, and mean pronation and supination were 85.5 and 83.5 degrees, respectively. Average strength loss was 15 percent. No elbow was unstable. The raw DASH score ranged from 39 to 62 points (normalized values, 0.66 to 15,79 points). On average, the carrying angle increased 5.4 degrees. Degenerative changes were absent in two, Grade I in four, and Grade II in four patients. Ectopic bone, mainly residual fracture fragments, was evident in four patients. Proximal migration of the radius averaged 1.6 millimeters; the two patients with over four millimeters of migration had mild wrist pain. CONCLUSIONS: Acute radial head excision for the treatment of elbow fracture-dislocations provides satisfactory short-term clinical results when there are no other associated intraarticular fractures. However, the long-term significance of the early degenerative changes is not known.     

桡骨小头假体置换治疗桡骨小头骨折

目的报告双极桡骨小头假体置换治疗严重桡骨小头粉碎性骨折的初步临床结果。方法自2002年8月～2005年6月采用双极人工桡骨小头假体(浮动杯假体)置换的方法治疗MasonⅢ、Ⅳ型桡骨小头骨折10例,新鲜骨折9例,陈旧性骨折1例。结果所有患者随访6～40个月,平均14.9个月,肘关节屈伸平均133.5°/9.0°,前臂旋前/旋后平均78.5°/84.0°,3例遗留肘关节轻度疼痛,1例肘关节轻度外翻不稳,3例肘关节轻度乏力。Broberg-Morrey肘关节功能评分平均93分,优6例,良3例,可1例,优良率为90%。结论双极桡骨小头假体置换治疗难以重建的桡骨小头骨折的近期效果满意,远期疗效有待进一步随访。     

Arthroplasty with a metal radial head for unreconstructible fractures of the radial head

BACKGROUND: Treatment of unreconstructible comminuted fractures of the radial head remains controversial. There is limited information on the outcome of management of these injuries with arthroplasty with a metal radial head implant. METHODS: The functional outcomes of arthroplasties with a metal radial head implant for the treatment of twenty-five displaced, unreconstructible fractures of the radial head in twenty-four consecutive patients (mean age, fifty-four years) were evaluated at a mean of thirty-nine months (minimum, two years). There were ten Mason type-III and fifteen Mason-Johnston type-IV injuries. Two of these injuries were isolated, and twenty-three were associated with other elbow fractures and/or ligamentous injuries. RESULTS: At the time of follow-up, Short Form-36 (SF-36) summary scores suggested that overall health-related quality of life was within the normal range (physical component = 47 +/- 10, and mental component = 49 +/- 13). Other outcome scales indicated mild disability of the upper extremity (Disabilities of the Arm, Shoulder and Hand score = 17 +/- 19), wrist (Patient-Rated Wrist Evaluation score = 17 +/- 21 and Wrist Outcome Score = 60 +/- 10), and elbow (Mayo Elbow Performance Index = 80 +/- 16). According to the Mayo Elbow Performance Index, three results were graded as poor; five, as fair; and seventeen, as good or excellent. The poor and fair outcomes were associated with concomitant injury in two patients, a history of a psychiatric disorder in three, comorbidity in two, a Workers' Compensation claim in two, and litigation in one. Subjective patient satisfaction averaged 9.2 on a scale of 1 to 10. Elbow flexion of the injured extremity averaged 140 degrees +/- 9 degrees; extension, -8 degrees +/- 7 degrees; pronation, 78 degrees +/- 9 degrees; and supination, 68 degrees +/- 10 degrees. A significant loss of elbow flexion and extension and of forearm supination occurred in the affected extremity, which also had significantly less strength of isometric forearm pronation (17%) and supination (18%) as well as significantly less grip strength (p < 0.05). Asymptomatic bone lucencies surrounded the stem of the implant in seventeen of the twenty-five elbows. Valgus stability was restored, and proximal radial migration did not occur. Complications, all of which resolved, included one complex regional pain syndrome, one ulnar neuropathy, one posterior interosseous nerve palsy, one episode of elbow stiffness, and one wound infection. CONCLUSIONS: Patients treated with a metal radial head implant for a severely comminuted radial head fracture will have mild-to-moderate impairment of the physical capability of the elbow and wrist. At the time of short-term follow-up, arthroplasty with a metal radial head implant was found to have been a safe and effective treatment option for patients with an unreconstructible radial head fracture; however, long-term follow-up is still needed.     

人工桡骨头置换术治疗桡骨头粉碎性骨折

目的 :探讨人工桡骨头假体置换术治疗桡骨头粉碎性骨折的近期疗效。方法:自2011年6月至2015年6月,采用人工桡骨头置换术治疗桡骨头粉碎性骨折25例,男10例,女15例;年龄24~61岁,平均40岁。分析不同时期患者患肢肘关节功能恢复情况,与健侧比较肘关节的活动度情况及末次随访时患侧肘关节功能评价情况。结果:25例均获随访,时间12~48个月,平均26个月,无感染、肘关节不稳定、下尺桡关节半脱位、骨化性肌炎等并发症发生。术后6、9个月及末次随访患者的VAS疼痛评分、Broberg和Morrey肘关节功能评分与术后3个月比较均改善(P0.05)。肘关节的屈伸活动度、旋转活动度在术后3、6、9个月与健侧差异有统计学意义(P0.01),但末次随访时与健侧比较差异无统计学意义(P0.05)。末次随访时根据Broberg和Morrey肘关节功能评分标准,优16例,良7例,可2例。结论 :人工桡骨头置换术治疗无法修复的桡骨头粉碎性骨折,能最大程度恢复肘关节的稳定性,早期进行功能锻炼,预防和减少并发症的发生,近期疗效满意,远期疗效待进一步观察。     

Nonunion of the radial head

A case of posterior fracture-dislocation of the elbow with a comminuted radial head fracture which subsequently went on to nonunion is reported. Radiographs at followup revealed a pseudoarthrosis of the radial neck, with at least part of the normal pronation and supination occurring through the pseudoarthrosis site.