Nalbantoglu Ufuk, Kocaoglu Baris, Gereli Arel, Aktas Seref, Guven Osman
Department of Orthopaedic Surgery and Traumatology, Acibadem Hospital, Istanbul, Turkey.
J Hand Surg Am. 2007 Dec;32(10):1560-8. doi: 10.1016/j.jhsa.2007.09.016.
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.
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.
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.
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.
本研究的目的是评估采用切开复位内固定、侧副韧带修复及早期活动的方法治疗伴有和不伴有肘关节脱位的Mason III型桡骨头骨折患者的疗效。另一个目的是研究肘关节脱位是否对严重程度和功能结局有任何影响。
25例患者采用低轮廓微型钢板和螺钉对桡骨头粉碎性骨折进行切开复位内固定治疗。18例骨折为Mason III型，7例骨折为伴有肘关节脱位的Mason III型。有5名女性和20名男性，平均年龄34岁。平均随访时间为27个月。对患者进行功能能力、体格检查和影像学评估。
Mason III型骨折组和伴有肘关节脱位的Mason III型骨折组的平均功能指数均为87。Mason III型骨折组肘关节平均活动范围为伸直5度至屈曲136度，伴有肘关节脱位的Mason III型骨折组为伸直7度至屈曲133度。所有患者的平均旋前和旋后角度分别为74度和67度。
对于选定的Mason III型桡骨头骨折和骨折脱位，内固定可使其获得满意的稳定性。精细的手术技术与坚强的内固定相结合，可使伴有和不伴有肘关节脱位及韧带损伤的Mason III型桡骨头骨折固定后早期进行前臂和肘关节活动。我们认为，对于无法通过切开复位内固定可靠治疗的粉碎性Mason III型桡骨头骨折，假体置换仍有其作用。
研究类型/证据水平：预后性研究II级。
