Lum Zachary C, Huish Eric G, Trzeciak Marc A
Doctors Medical Center, Orthopaedic Surgery Department, Graduate Medical Education, 1441 Florida Ave, Modesto, CA, 95350, United States of America.
J Orthop. 2018 Jan 16;15(1):78-80. doi: 10.1016/j.jor.2018.01.013. eCollection 2018 Mar.
When approaching radial head and neck fractures, the decision for ORIF, resection, or arthroplasty is often performed intraoperatively. Factors that contribute include ligamentous and bony stability, cartilage injury, mechanical alignment as well as patient factors. Recent data has suggested conventional methods may not be sufficiently sensitive in detecting Essex Lopresti injuries. Here we describe an intraoperative technique that could objectively assess proximal radio-ulnar stability with subsequent disruption of the ligamentous structures.
Eight cadaveric specimens were used to evaluate amount of radial proximal migration between three groups of forearms. After radial head resection, proximal migration of the radial shaft was measured in three distinct groups. Group A included intact forearms, Group B included forearms with resected interosseous membranes (IOM), and Group C included forearms with resected interosseous membranes and distal radioulnar joint (DRUJ) disruptions.
As compared to group A, group B averaged 4 mm of proximal radial migration (p < 0.01), while Group C demonstrated >6 mm of migration (p < 0.01).
In the setting of a non-repairable radial head, the RAIL test may provide a more objective means of assessing for Essex-Lopresti injuries.
在处理桡骨头和颈部骨折时，通常在术中决定采用切开复位内固定术（ORIF）、切除术或关节成形术。相关因素包括韧带和骨骼稳定性、软骨损伤、机械对线以及患者因素。最近的数据表明，传统方法在检测埃克塞斯-洛普雷斯蒂损伤（Essex Lopresti injuries）时可能不够敏感。在此，我们描述一种术中技术，该技术可以客观评估近端桡尺关节稳定性以及随后韧带结构的破坏情况。
使用八个尸体标本评估三组前臂之间桡骨近端移位的程度。在切除桡骨头后，测量三组不同情况下桡骨干的近端移位。A组包括完整的前臂，B组包括切除骨间膜（IOM）的前臂，C组包括切除骨间膜且远侧桡尺关节（DRUJ）脱位的前臂。
与A组相比，B组桡骨近端平均移位4毫米（p < 0.01），而C组移位超过6毫米（p < 0.01）。
在不可修复的桡骨头情况下，RAIL试验可能提供一种更客观的方法来评估埃克塞斯-洛普雷斯蒂损伤。
