1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece.
School of Electrical and Computer Engineering of Aristotle University, 54124 Thessaloniki, Greece.
Orthop Traumatol Surg Res. 2018 Oct;104(6):853-857. doi: 10.1016/j.otsr.2018.02.007. Epub 2018 Mar 23.
We asked whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA), common techniques used for the confrontation of displaced or comminuted radial head fractures, are correlated with cartilage wear of the capitulum.
We hypothesized that neither ORIF nor RHA are correlated with capitellar cartilage wear.
On 5 cadaveric elbow specimens, osteotomies were employed to simulate radial head comminuted fractures followed with ORIF by Herbert screws. Radial heads were also excised from other 5 cadaveric elbow specimens and were replaced by metallic monopolar implants. Finally, 2 elbows were not operated and used as a control group. Custom-made rotary machines, working unstoppably, generated 700,000 pronation and supination forearm movements at a 110° arc of motion. The elbow joints were examined with pre- and postoperative magnetic resonance imaging (MRI) scans and the articular surfaces of the capitula were resected and sent for histopathology study.
In the 2 cadaveric elbows of the control group and the 4 elbows treated with ORIF, no cartilage damage was found. The fifth one displayed cartilage fissures, which were, classified according to International Cartilage Repair Society (ICRS) grading system as grade I cartilage damage. On the contrary, all 5 elbows treated with RHA sustained complete cartilage loss, exposure of the subchondral bone and were classified as ICRS grade IV cartilage damage.
Our study suggests that metallic monopolar RHA after a displaced or comminuted radial head fracture carries a high risk of rapidly evolving cartilage loss of the capitulum.
我们研究了用于治疗移位或粉碎性桡骨头骨折的切开复位内固定（ORIF）或桡骨头置换术（RHA）是否与桡骨头软骨磨损有关。
我们假设 ORIF 和 RHA 均与桡骨头软骨磨损无关。
在 5 个尸体肘部标本中，通过截骨术模拟桡骨头粉碎性骨折，然后用 Herbert 螺钉进行 ORIF。另外 5 个尸体肘部标本的桡骨头被切除，并用金属单极植入物替代。最后，2 个肘部未进行手术，作为对照组。定制的旋转机器持续不断地工作，在前臂以 110°的弧形进行 700,000 次旋前和旋后运动。在术前和术后进行磁共振成像（MRI）扫描检查肘部关节，并切除桡骨头关节面进行组织病理学研究。
在对照组的 2 个尸体肘部和接受 ORIF 治疗的 4 个肘部中，未发现软骨损伤。第 5 个肘部显示软骨裂隙，根据国际软骨修复协会（ICRS）分级系统分类为 I 级软骨损伤。相反，接受 RHA 治疗的 5 个肘部均发生完全软骨丧失，软骨下骨暴露，被归类为 ICRS 分级 IV 级软骨损伤。
我们的研究表明，移位或粉碎性桡骨头骨折后使用金属单极 RHA 会导致桡骨头软骨迅速丧失的风险很高。
