Ring David, Quintero Jaime, Jupiter Jesse B
Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Bone Joint Surg Am. 2002 Oct;84(10):1811-5. doi: 10.2106/00004623-200210000-00011.
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.
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.
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.
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.
本回顾性研究的目的是分析桡骨头骨折切开复位内固定术后的功能结果，并确定哪种骨折类型最适合这种治疗方法。
对56例接受桡骨头关节内骨折切开复位内固定治疗的患者进行评估，平均受伤后48个月。30例患者为Mason 2型（部分关节面）骨折，26例为Mason 3型（完全关节面）骨折。56例骨折中有27例合并前臂或肘关节骨折脱位或内侧副韧带损伤。30例2型骨折中有15例为粉碎性骨折。26例3型骨折中有14例骨折块超过三块，12例骨折块为两块或三块。如果出现内固定早期失败或骨不连需要二次手术切除桡骨头、前臂旋转小于100度，或根据Broberg和Morrey评分系统评定为一般或较差，则最终评估结果判定为不满意。
15例桡骨头粉碎性Mason 2型骨折患者中有4例结果不满意；这4例骨折均合并前臂或肘关节骨折脱位，且4例患者前臂旋转均小于100度。14例Mason 3型粉碎性骨折且关节面骨折块超过三块的患者中有13例结果不满意。相比之下，所有15例孤立的、非粉碎性2型骨折患者结果均满意。12例桡骨头骨折块分为两块或三块的3型骨折患者中，无一例出现内固定早期失败，1例出现骨不连，且所有患者前臂旋转弧度均大于或等于100度。
尽管目前用于小关节面骨折内固定的植入物和技术使大多数桡骨头骨折的修复成为可能，但我们的数据表明，切开复位内固定最好仅用于关节面骨折块为三块或更少的轻度粉碎性骨折。肘关节或前臂合并骨折脱位也可能影响桡骨头修复的长期效果，尤其是在前臂旋转功能恢复方面。
