von Glinski A, Rausch V, Königshausen M, Dudda M, Schildhauer T A, Seybold D, Geßmann J
Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland.
Unfallchirurg. 2019 Mar;122(3):219-224. doi: 10.1007/s00113-018-0504-9.
Radial head fractures are the most frequent fractures of the elbow joint in adults. For Mason type II fractures without concomitant injuries favorable results have been shown with operative and conservative management. There is insufficient evidence concerning elbow joint stability after conservative treatment compared to open reduction and internal fixation (ORIF).
All patients with isolated Mason type II (two part fracture displaced >2 mm and <5 mm) radial head fractures between 1 January 2003 and 1 April 2013 were retrospectively reviewed. Exclusion criteria were age <18 years, associated fractures of the ipsilateral extremity or elbow luxation. A total of 50 patients (mean age 44.2 years, range 19-71 years) who received either ORIF (n = 31) or conservative treatment (n = 19) were included. The mean follow-up was 43.2 months (range 9-61 months). Patients were evaluated using the Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance score (MEPS), and Oxford Elbow score (OES). Joint stability (varus and valgus stress) was assessed under fluoroscopy and a distinction was made between slight instability (angulation <10°), moderate instability (angulation ≥10°) and gross instability (elbow dislocation).
Residual fracture displacement (conservative: 2.7 mm, ORIF: 1.4 mm, p < 0.042) and varus/valgus joint stability (3% ORIF vs. 26% conservative, p = 0.031) showed significant differences. The stability as tested by a radiological dynamic procedure showed an instability after ORIF in 3% of the joints compared to 26% after conservative treatment; however, this did not influence the short to mid-term clinical outcome: No significant differences were found in the DASH score (conservative 33 points, ORIF 36 points), MEPS (conservative 76 points, ORIF 78 points) and OES (conservative 41 points, ORIF 43 points).
Both conservative management and operative treatment had a good functional outcome. Operative treatment showed a positive tendency concerning radiological and functional outcome without statistical significance.
桡骨头骨折是成人肘关节最常见的骨折。对于无合并伤的梅森（Mason）II型骨折，手术治疗和保守治疗均显示出良好的效果。与切开复位内固定术（ORIF）相比，关于保守治疗后肘关节稳定性的证据不足。
回顾性分析2003年1月1日至2013年4月1日期间所有孤立性梅森II型（两部分骨折，移位>2毫米且<5毫米）桡骨头骨折患者。排除标准为年龄<18岁、同侧肢体合并骨折或肘关节脱位。共纳入50例患者（平均年龄44.2岁，范围19 - 71岁），其中接受ORIF治疗的患者31例，接受保守治疗的患者19例。平均随访时间为43.2个月（范围9 - 61个月）。使用手臂、肩部和手部功能障碍（DASH）评分、梅奥肘关节功能评分（MEPS）和牛津肘关节评分（OES）对患者进行评估。在透视下评估关节稳定性（内翻和外翻应力），并区分轻度不稳定（成角<10°）、中度不稳定（成角≥10°）和严重不稳定（肘关节脱位）。
骨折残留移位（保守治疗：2.7毫米，ORIF治疗：1.4毫米，p < 0.042）和内翻/外翻关节稳定性（ORIF治疗为3%，保守治疗为26%，p = 0.031）存在显著差异。通过放射学动态检查测试的稳定性显示，ORIF治疗后3%的关节存在不稳定，而保守治疗后为26%；然而，这并未影响短期至中期的临床结果：DASH评分（保守治疗33分，ORIF治疗36分）、MEPS（保守治疗76分，ORIF治疗78分）和OES（保守治疗41分，ORIF治疗43分）均无显著差异。
保守治疗和手术治疗均取得了良好的功能结果。手术治疗在放射学和功能结果方面显示出积极趋势，但无统计学意义。
