Ünlü Mehmet Can, Güven Mehmet Fatih, Aslan Lercan, Aydıngöz Önder, Bilgili Mustafa Gökhan, Bayrak Alkan, Babacan Muharrem, Kaynak Gökhan, Botanlıoğlu Hüseyin
Department of Orthopedics and Traumatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2018 Jul;24(4):359-363. doi: 10.5505/tjtes.2017.97682.
The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis.
Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side.
Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, -10.00° and -25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°.
Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.
桡骨头对于前臂的旋转稳定性及抵抗外翻应力至关重要。桡骨头骨折是成人最常见的肘部骨折。根据骨折严重程度，有多种治疗选择。然而，III型骨折的治疗存在争议。本研究的目的是评估接受桡骨头切除或假体植入治疗的无法修复的梅森III型桡骨头骨折患者的功能结果。
在这项多中心回顾性研究中，评估了14例接受桡骨头切除（n = 7）或桡骨头假体植入（n = 7）治疗的无法修复的梅森III型桡骨头骨折患者。采用上肢、肩部和手部功能障碍（DASH）评分以及梅奥肘部和腕部评分来确定临床结果。使用液压式握力计测量手术侧和非手术侧的握力，以避免潜在偏差。每个肢体测量三次，记录平均值。握力计算为非手术侧力量的百分比。
切除组和假体植入组的功能结果如下：平均DASH评分分别为25.8和17.2；平均梅奥肘部评分分别为74和84.1；平均梅奥腕部评分分别为84和92.5；最大握力分别为48.8%和77.8%。各自的切除组和假体植入组的活动范围如下：屈曲分别为112.14°和104.29°；伸展分别为-10.00°和-25.00°；旋前分别为70.00°和47.86°；旋后分别为70.00°和52.14°。
尽管桡骨头切除组的活动范围受限，但接受桡骨头假体植入治疗的患者功能结果和握力更佳。这些结果支持对于无法修复的梅森III型桡骨头骨折患者，桡骨头假体植入在患者满意度和功能结果方面是一种更优的治疗方式。
