Radial head replacement with a pyrocarbon head prosthesis: preliminary results of a multicentric prospective study

The authors present the preliminary results of a multicentric prospective study of 30 cases treated by a new radial head prosthesis (MoPyc). This new modular radial head prosthesis is composed of a cementless titanium stem and a 15° angulated neck. The head is in pyrocarbon and enables an optimal couple of friction between the implant and cartilage. This multicentric prospective study includes 30 patients (19 men and 11 women, mean age 50 years). The mean follow-up was 18 months (6–29 months). The main etiology was a radial head fracture with elbow instability. The post-operative evaluation was clinical and included the Broberg–Morrey score and the Mayo Clinic Elbow Performance Score (MEPS). The radiological evaluation included the stability of the elbow, the fixation of the prosthesis and the interface between the pyrocarbon head and the humeral condyl and the distal radio-ulnar joint. At the time of follow-up, the average Broberg–Morrey score was 88/100, with 77% of good and excellent results. The average MEPS was 95/100, with 97% of good and excellent results. Elbow flexion averaged 122°, extension −15°, pronation 74° and supination 72°. Elbow stability was good in all the cases, and no proximal migration of the radius occurred. Asymptomatic bone lucencies were found in five cases (three stress shieldings, under the neck of the prosthesis, two around the stem). Complications included two cases of proximal radio-ulnar synostosis and one under stuffing of the prosthesis (which was re-operated shortly after the first implantation) with a good final result. One case demonstrated a tendency to posterior subluxation during heavy work. The preliminary results of 30 patients treated by this radial head prosthesis with a pyrocarbon head are encouraging at a follow-up of 18 months. The shape and the modularity of this prosthesis provide a good stability and function of the elbow and allow an easy implantation regardless of the level of resection. The contact between the articular surfaces and the pyrocarbon head should ensure the durability of this arthroplasty. However, a longer follow-up is required.

人工桡骨头置换治疗桡骨头粉碎性骨折

目的探讨应用单极人工桡骨头假体置换治疗MasonⅢ、Ⅳ型桡骨头骨折的疗效。方法对15例MasonⅢ、Ⅳ型桡骨头骨折患者应用人工桡骨头假体进行置换并观察疗效。结果 15例均获随访,时间6～30个月。按Mayo肘关节功能评分评定：优9例,良5例,可1例。无感染发生。结论桡骨头在稳定肘关节及上尺桡关节中起着至关重要的作用,桡骨头骨折如不能修复,假体置换是更好的选择。     

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.     

人工桡骨头置换应用体会

2006年5月～2011年4月,我们应用单极人工桡骨头假体置换治疗9例桡骨头严重粉碎骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组9例,男6例,女3例,年龄38～56岁。左侧4例,右侧5例。骨折按照Mason分类:Ⅲ型3例,Ⅳ     

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。     

36例桡骨头骨折的治疗体会

目的探讨桡骨头骨折的治疗方法、手术技术及治疗效果。方法对36例桡骨头骨折患者中7例（Ⅰ型）采用非手术治疗,29例（Ⅰ～Ⅳ型）采用切开复位微型接骨板螺钉或单用螺钉固定。结果患者均获随访,时间2～36个月。肘关节屈曲幅度为100°～145°,前臂旋转幅度为65°～160°。按Broberg-Morrey评估标准进行功能评定：优21例,良14例,可1例。结论对桡骨头骨折大部分Ⅰ型患者可采用非手术治疗,对部分Ⅰ型和Ⅱ～Ⅳ型者采用切开复位微型接骨板、螺钉内固定治疗,疗效均满意。     

Surgical management of Mason type III radial head fractures

The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities.     

不同类型桡骨头骨折的治疗

目的 探讨不同类型桡骨头骨折的治疗方法及疗效.方法 2004年2月至2008年4月收治的57例桡骨头骨折的患者,根据Mason分型,其中Ⅰ型12例、Ⅱ型24例、Ⅲ型19例、Ⅳ型2例.针对不同类型骨折选择相应的治疗方法.结果 术后随访时间为18～48个月,平均28.4个月.根据Broberg和Morrey肘关节功能评分标准评定:优29例,良18例,可9例,差1例;优良率为82.5％.术后无一例发生肘部感染和神经损伤,1例发生骨不连,4例有创伤性关节炎表现,3例发生异位骨化,1例有肘关节不稳定表现.其中MasonⅢ、Ⅳ型骨折患者术后患侧肘关节活动范围小于健侧,差异有统计学意义(P＜0.05).结论 单纯MasonⅠ型骨折可行保守治疗;Ⅱ型骨折治疗需慎重,存在肘关节不稳定的需行切开复位内固定术;Ⅲ、Ⅳ型骨折可行切开复位内固定或桡骨头置换术,同时注意修补或重建韧带以稳定肘关节,对桡骨头切除要谨慎.     

Comminuted fractures of ipsilateral radial head and distal radius: A rare injury pattern

A new injury pattern of comminuted fractures of ipsilateral radial head and distal radius of forearm in an adult was described. To the best of our knowledge, this type of injury pattern had not been previously reported in the English literature. The possible mechanisms of injury were that the rebound forces were volar to the distal radius as the fracture was dorsally angulated, with a continuation of the radial head fracture due to the longitudinal impaction of the radius against the capitellum. Open reduction and internal fixation can obtain excellent results within 7e12 days after injury. We hope that our experience will increase the awareness of the occurrence of a double injury of the forearm.     

手术治疗非严重粉碎性桡骨头骨折体会

目的介绍应用微型空心螺钉固定非严重粉碎性桡骨头骨折的方法和疗效。方法采用Koche入路,对27例患者行桡骨头及关节面复位,微型空心螺钉内固定治疗。按改良的Mason分类法分类,Ⅱ型18例,Ⅲ型5例,Ⅳ型4例。23例术前行CT检查和三维重建。结果术后随访12~18个月,平均14个月。优17例,良7例,一般3例。无一例发生骨不连、关节僵直或再脱位。结论微型空心螺钉治疗非严重粉碎的桡骨头骨折创伤小,简便易行,疗效好。术前行CT检查和三维重建可为此类术式的选择提供可靠依据。