Cha Soo-Min, Shin Hyun-Dae, Kim Kyung-Cheon, Song Jae-Hwang
Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Hand Surg. 2013;18(3):389-92. doi: 10.1142/S0218810413720210.
Non-union of radial neck fractures is not common in adults, and surgical treatment is rarely required. This case report documents non-union of the radial neck with persistent pain around the elbow joint and tenderness over the neck of the radius, limited range of motion for 12 months. The authors performed an iliac bone graft and temporary K-wire fixation for non-union of the radial neck after an isolated radial neck fracture.
A 54-year-old woman slipped with her hand outstretched 12 months prior to presentation. She was diagnosed with a radial neck fracture, but her injury was eventually diagnosed as a non-union fracture, and she was transferred to our hospital. The patient had tenderness of the radial head and neck and an increasing tendency of pain in the forearm during external rotation with resistance. Flexion was a maximum of 80°, extension was limited to 20°, and internal rotation and external rotation were decreased to 60°. On plain radiographs, a clear radiolucent shadow was present between the bone fragment and radius. After the autogenous iliac bone graft, a temporary K-wire was fixed, and at eight weeks postoperatively, the bone was united. The patient is in the month 24 of postoperative follow-up and is able to perform daily activities without tenderness.
If elbow joint pain, tenderness, and limitation of range of motion are present in non-union of radial neck fracture, surgical treatment is necessary. If there is no injury to the ligament around the elbow or instability, the authors consider bone graft and temporary K-wire fixation as an excellent treatment option for bony union and early exercise of the joint.
桡骨颈骨折不愈合在成人中并不常见，很少需要手术治疗。本病例报告记录了桡骨颈骨折不愈合，伴有肘关节周围持续疼痛、桡骨颈压痛，活动受限12个月。作者对单纯桡骨颈骨折后桡骨颈不愈合患者进行了髂骨植骨及临时克氏针固定。
一名54岁女性在就诊前12个月伸手时滑倒。她最初被诊断为桡骨颈骨折，但最终被诊断为骨折不愈合，并被转至我院。患者桡骨头和颈部有压痛，前臂在外旋抗阻时疼痛有加重趋势。屈曲最大为80°，伸展受限至20°，内旋和外旋均降至60°。X线平片显示骨碎片与桡骨之间有明显的透亮影。自体髂骨植骨后，临时固定克氏针，术后8周骨愈合。患者术后随访24个月，能够进行日常活动且无压痛。
如果桡骨颈骨折不愈合出现肘关节疼痛、压痛及活动受限，手术治疗是必要的。如果肘关节周围韧带无损伤或无不稳定情况，作者认为植骨及临时克氏针固定是促进骨愈合及早期关节活动的极佳治疗选择。
