Kusnezov Nicholas, Eisenstein Emmanuel, Dunn John C, Fares Austin, Mitchell Justin, Kilcoyne Kelly, Waterman Brian R
1 William Beaumont Army Medical Center, Fort Bliss, TX, USA.
2 Creighton University School of Medicine, Omaha, NE, USA.
Hand (N Y). 2018 Jul;13(4):473-480. doi: 10.1177/1558944717715136. Epub 2017 Jun 27.
Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands.
A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures.
A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05).
Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.
桡骨头和颈部骨折是普通成年人群中最常见的肘部骨折；然而，桡骨头骨折的最佳治疗方法仍是临床中持续存在争议的话题。本研究的目的是确定在对上肢功能要求较高的年轻活跃患者群体中，不稳定桡骨头骨折手术治疗后的功能恢复率、并发症及再次手术情况。
查询军事医疗数据库，纳入2010年至2015年间所有接受切开复位内固定术（ORIF；当前手术操作术语[CPT]代码：24665）和桡骨头置换术（RHA；CPT代码：24666）的美国军人。纳入所有至少随访2年的患者。进行单因素分析和卡方分析，以评估潜在风险因素与主要结局指标之间的关联。
共纳入67例接受ORIF（n = 69肘）的患者和10例接受RHA的患者。平均年龄为31±8.0岁。平均随访3.5±1.1年时，总体上90%的患者能够重返现役，其中96%的患者上肢功能不受限。近三分之一（31.2%）的患者发生了至少1种术后并发症。与ORIF相比，RHA总体并发症发生率更高（70%对48%），但这一发现未达到统计学意义（P = 0.073）。然而，RHA的植入物失败率显著更高（20%对2.9%，P = 0.0498）。17例（21%）患者需要再次手术，其中5例（6.3%）为翻修手术。脱位、冠状突骨折和同时进行的韧带修复预示发生1种或更多并发症的风险显著增加（P < 0.05），而脱位和韧带修复需求独立预测翻修手术（P < 0.05）。
对于年轻、活跃人群中的不稳定桡骨头骨折，置换术和ORIF都是可行的治疗选择，尽管RHA并发症增加，但二者功能恢复情况相当。
