Jordan Robert W, Jones Alistair Dr
University Hospitals Coventry & Warwickshire, UK.
Worcester Royal Hospital, Worcester, UK.
Open Orthop J. 2017 Nov 30;11:1405-1416. doi: 10.2174/1874325001711011405. eCollection 2017.
Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries.
A literature search was performed and the authors' personal experiences are reported.
Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon's ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation.
We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.
桡骨头骨折是成人常见的肘部损伤，常伴有其他软组织和骨骼损伤。
进行文献检索并报告作者的个人经验。
梅森I型骨折采用夹板固定和早期活动进行非手术治疗。梅森II型损伤的治疗尚不明确，有证据支持非手术治疗和内固定。非手术治疗可接受的关节内移位和成角程度尚未最终确定。同样，III型和IV型骨折的治疗仍存在争议。传统的桡骨头切除术与外翻不稳定有关，仅应考虑功能需求较低的患者。比较研究表明，内固定的效果优于切除术。只有在能够实现解剖复位并开始早期活动时，才应尝试内固定。作者报告说，如果存在三个以上的骨折块，固定效果较差且并发症发生率较高。桡骨头置换术旨在重建天然的桡骨头，适用于内固定不可行且存在复杂肘部损伤的情况。桡肱关节填充过多是常见的技术失误，对肘部生物力学有重大不利影响。模块化设计提高了外科医生重建天然关节的能力。两项随机对照试验表明，与内固定相比，置换术后临床结果改善且并发症发生率较低。
我们已经介绍了各种类型桡骨头骨折的治疗细节——然而，仍需要进一步的证据来明确这些不同治疗策略的作用。
