Displaced Operable Radial Head Fractures

Background  Radial head fractures are common injuries occurring in conjunction with other injuries. We hypothesize that the associated injuries are under-diagnosed, under-treated and are under-estimated in terms of their relevance to the patients final functional outcome. We hypothesize a high correlation between the associated injuries and poor functional scores. Materials  Thirty-nine displaced radial head fractures were clinically, radiologically and functionally assessed at an average of 47 months postoperatively. Demographic data, case notes, and follow up data were statistically analyzed. Pearson’s correlation coefficient was performed for the associated injuries and final functional scores. Results  There were 21 type II and 18 type III radial head fractures. About 52% of Mason type II (11/21) and 94% of the Mason type III (17/18) had associated injuries. The average Mayo Elbow Performance Score for the Mason II fractures was 70 and for the Mason III was 55. There was a strong correlation between the number of associated injuries and functional scores. For Mason II injuries the Pearson correlation coefficient was r = −0.994, and for the Mason III group, r = −0.972. Conclusions  “Isolated radial head fractures” are rare. All displaced radial head fractures need thorough clinical and radiographic evaluation. The associated injuries are often unappreciated on initial diagnosis and are often under-treated. Associated injuries are strongly correlated with poor functional scores and therefore need to be addressed during surgery.     

桡骨头切除术后并发症分析

１５例桡骨头术获得３年以上随访，常见并发症有中酸软，疼痛及不适。患侧握力降低，肘关节伸屈和前臂旋转受限。Ｘ线发迹有提携角增大，下桡尺关节半脱位及肘关节炎。作者认为桡骨头切除应作为改善功能的最后造反少处儿童尽量避免采用此方法。     

金属桡骨小头置换治疗粉碎性桡骨小头骨折的早期疗效观察

目的探讨骨水泥型钛金属桡骨小头置换治疗粉碎性桡骨小头骨折的早期疗效。方法对10例严重的粉碎性桡骨小头骨折进行骨水泥型钛金属桡骨小头置换,其中MasonⅢ型骨折6例,Ⅳ型骨折4例,合并肱骨骨折1例。通过物理检查、功能评分指数和影像学对疗效进行评价。评价指标包括活动度、稳定性、疼痛和抓握力量。结果所有患者均获得随访,平均随访时间23·7个月(18~31个月)。无感染、假体植入失败、异位骨化或脱位发生。功能评分显示优5例,良4例,一般1例。结论当内侧副韧带损伤后,桡骨小头成为防止肘外翻和旋转不稳定的主要结构。骨水泥型人工钛金属桡骨小头置换后,其提供的稳定性接近于生理状态下的自体桡骨头。MasonⅢ型和MasonⅣ型桡骨小头骨折是进行金属桡骨小头置换的指征。     

Radial Head Fractures: Indications and Technique for Primary Arthroplasty

Abstract The treatment of complex radial head fractures remains a challenge for the orthopedic surgeon. Novel implants and improved surgical techniques have made reconstruction of the radial head with open reduction and internal fixation possible in most cases. However, extremely comminuted radial head fractures with associated instabilities still require replacement of the radial head with a prosthesis to allow rehabilitation with early motion of the elbow, and thereby optimizing the functional results of these potentially devastating injuries. In this article we discuss the surgical considerations related to radial head replacement, encompassing the indications for radial head arthroplasty, implant selection, surgical technique, rehabilitation protocols, and complications related to radial head prosthesis.     

桡骨头骨折的治疗及其疗效分析

目的：根据桡骨头在前臂的生物力学作用，对桡骨头骨折不同的治疗方法及结果进行研究，寻求一种合理、有效的桡骨头骨折的治疗方法。方法：对49例桡骨头骨折的病人随访调查，对非手术治疗的14例（MasonⅡ型），切开复位内固定治疗的29例（Mason Ⅱ型19例，Mason Ⅲ型10例），及桡骨头切除的6例按照Geel和Palmer评分标准对其结果进行评估。结果：平均随访2．8年（2－5．5年）。非手术治疗的优良率为85．7％（12／14），切开复位内固定的优良率为78．6％（22／29），桡骨头切除的优良率仅为33．3％（2／6），总率为73．5％（36／49）。结论：对桡骨头骨折应尽量通过手术或非手术方法恢复其正常解剖关系，保持前臂矩形框架生物力学的稳定，对桡骨小头切除要慎重。     

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19例,MasonⅡ型12例,Ⅲ型4例,Ⅳ型3例。17例用肘后外侧Kocher切口,另外2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。结果平均随访38.5个月,无骨间后神经损伤及感染发生,19例骨折均顺利愈合。按照Broberg和Morrey肘部评分标准:优13例,良6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。     

Medial Humeral Condyle Fracture with an Ipsilateral Dislocated Radial Head

We present the first reported case of a combined medial humeral condyle fracture with ipsilateral radial head dislocation. This injury was sustained by a 7-year-old girl following a fall on an outstretched hand. The operative technique is described. At 6-month follow-up, the patient had normal alignment of the limb and achieved full range of motion.     

Diagnostic Accuracy of Two-Dimensional and Three-Dimensional Imaging and Modeling of Radial Head Fractures

To tests the hypothesis that classification and characterization of fractures of the radial head is more accurate with 3D than 2D computed tomography images and radiographs, using a prospective study design with intraoperative inspection as the reference standard. Treating surgeons and first assistants completed a questionnaire assigning a fracture type according to the Broberg and Morrey modification of Mason’s classification, evaluating selected fracture characteristics, and electing preferred management based upon radiographs and 2D images alone; then adding 3D-CT; then 3D printed physical models; and finally intra-operative visualization. The addition of the 3D CT and physical models improved the sensitivity for fracture line separating the entire head from the neck, comminution of the radial neck, fracture involving the articular surface, articular fracture gap greater than 2 mm, impacted fracture fragments, greater than 3 articular fragments, and articular fragments judged too small to repair. There were no significant differences in diagnostic performance with the addition of 3D models. The addition of 3D CT and models improved the reliability of Broberg and Morrey classification. We conclude that 3DCT and 3D physical modeling provide more accurate fracture classification and characterization of fracture of the radial head with less proposed variability in treatment. We did not demonstrate a clear advantage for modeling over 3DCT reconstructions. Level of Evidence: Diagnostic, Level I