Duckworth Andrew D, Wickramasinghe Neil R, Clement Nicholas D, Court-Brown Charles M, McQueen Margaret M
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
J Bone Joint Surg Am. 2014 Oct 15;96(20):1716-23. doi: 10.2106/JBJS.M.01354.
There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management.
From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score.
The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006).
Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
有证据支持对单纯性桡骨头稳定骨折进行一期非手术治疗，尽管关于长期疗效的数据极少。本研究的目的是报告一期非手术治疗后桡骨头和颈部单纯性稳定骨折的主观长期疗效。
从一个桡骨近端骨折的前瞻性数据库中，我们确定了所有在18个月期间发生单纯性稳定的梅森1型或2型桡骨头或颈部骨折的骨骼成熟患者。纳入标准为确诊的桡骨近端单纯性稳定骨折，主要采用非手术治疗。主要的长期疗效指标是手臂、肩部和手部功能障碍（DASH）评分。
研究队列包括100例患者，平均年龄46岁（范围17至79岁）。所有损伤中有69%是从站立高度跌落所致。35%的患者有一种或多种合并症。有57例梅森1型骨折和43例梅森2型骨折。在受伤后平均10年（范围8.8至10.2年）时，平均DASH评分为5.8（范围0至67.2），平均牛津肘关节评分（OES）为46（范围14至48）。14例（14%）患者报告有僵硬感，24例（24%）患者报告有一定程度的疼痛。较差的DASH评分与年龄较大（p = 0.002）、有一种或多种合并症（p = 0.008）、根据多重剥夺指数五分位数衡量的社会经济剥夺程度增加（p = 0.026）、骨折移位量增加（p = 0.041）以及参与赔偿程序（p = 0.006）相关。
桡骨头或颈部单纯性稳定骨折非手术治疗后的长期患者报告疗效极佳。我们建议对这些骨折进行常规一期非手术治疗可为大多数患者提供满意的疗效，在我们的研究中很少有患者因持续不适需要进一步干预。
治疗性四级。有关证据水平的完整描述，请参阅作者须知。
