Sandmann G H, Crönlein M, Neumaier M, Beirer M, Buchholz A, Stöckle U, Biberthaler P, Siebenlist S
Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
BG Unfallklinik Tübingen, Eberhard-Karls- University, Tuebingen, Germany.
Eur J Med Res. 2016 Apr 12;21:15. doi: 10.1186/s40001-016-0210-4.
Isolated radial neck fractures occur only in rare cases. The majority of cases are non-displaced or minimally displaced and can be treated conservatively. Conservative treatment, however, might result in secondary displacement and/or malunion. On the other hand, open reduction and internal fixation (ORIF) as standard surgical approach in adults is associated with non-union, implant-related complications and reduced range of motion. For isolated radial neck fractures with an intact radial head, the procedure of centromedullary pinning--as widely used in the treatment of paediatric radial neck fractures--might be an alternative operative technique in adults as well. The purpose of this retrospective case series therefore was to evaluate the functional outcome of radial neck fractures treated by intramedullary pinning.
Between 02/2009 and 12/2014, a total of eight patients with isolated radial neck fractures (Mason type-III; Judet Type II and III) were treated with centromedullary pinning using titanium elastic nails (TEN). The mean age of the patients was 39 years (range 23-90 years) with a mean interval from injury to surgery of 2.9 days (range 1-7 days). Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey Elbow Score (MEPS), the QuickDASH and the Elbow Self Assessment Score (ESAS). Furthermore, follow-up radiographs were evaluated.
Seven of the eight patients were available for follow-up after a mean of 36 months (range 6-64 months). Patients' satisfaction was rated very good in four cases, good in two cases and sufficient in one case. An unrestricted active ROM compared to the contralateral side for extension-flexion arc and for pronation-supination-arc with full strength was rated in all cases. The Elbow Self Assessment Score was 98.52 ± 1.95 (range 96-100), the calculated Mayo elbow performance score was 95.71 ± 7.32 (range 85-100) and the QuickDASH score was 6.81 ± 10.42 (range 0-27). There were no complications as infection, non-union, heterotopic ossifications or secondary loss of reduction of the radial head. Only one patient complained about pain resulting from an affection of the superficial radial nerve.
In the present cohort, good to excellent results without relevant complications were seen. The technique of intramedullary pinning as described in the treatment of isolated radial neck fractures in children represents a suitable and reliable method in adults as well. In selected cases, this technique can be recommended as an alternative, minimal-invasive approach to the radial head plate osteosynthesis.
孤立性桡骨颈骨折仅在极少数情况下发生。大多数病例为无移位或轻微移位，可采用保守治疗。然而，保守治疗可能导致二次移位和/或畸形愈合。另一方面，成人采用切开复位内固定（ORIF）作为标准手术方法，存在骨不连、植入物相关并发症以及活动范围减小等问题。对于桡骨头完整的孤立性桡骨颈骨折，髓内穿针术——广泛应用于儿童桡骨颈骨折的治疗——在成人中也可能是一种替代手术技术。因此，本回顾性病例系列的目的是评估髓内穿针治疗桡骨颈骨折的功能结果。
2009年2月至2014年12月期间，共有8例孤立性桡骨颈骨折（梅森III型；朱代II型和III型）患者采用钛弹性钉（TEN）进行髓内穿针治疗。患者的平均年龄为39岁（范围23 - 90岁），受伤至手术的平均间隔时间为2.9天（范围1 - 7天）。主观和客观标准包括患者满意度、视觉模拟量表（VAS）疼痛评分以及与对侧上肢相比的主动活动范围（ROM）。功能评分包括莫里肘关节评分（MEPS）、快速残疾评定量表（QuickDASH）和肘关节自我评估评分（ESAS）。此外，还对随访X线片进行了评估。
8例患者中有7例在平均36个月（范围6 - 64个月）后可进行随访。4例患者的满意度被评为非常好，2例为好，1例为尚可。所有病例中，与对侧相比，屈伸弧和旋前 - 旋后弧的主动活动范围不受限且力量完全正常。肘关节自我评估评分为98.52 ± 1.95（范围96 - 100），计算得出的梅奥肘关节功能评分是95.71 ± 7.32（范围85 - 100），快速残疾评定量表评分为6.81 ± 10.42（范围0 - 27）。没有发生感染、骨不连、异位骨化或桡骨头二次复位丢失等并发症。只有1例患者抱怨因桡浅神经受累而疼痛。
在本队列中，观察到了良好至优异的结果且无相关并发症。儿童孤立性桡骨颈骨折治疗中所描述的髓内穿针技术在成人中也是一种合适且可靠的方法。在某些选定病例中，该技术可作为桡骨头钢板内固定术的一种替代的微创方法推荐使用。
