Laun R, Tanner S, Grassmann J-P, Schneppendahl J, Wild M, Hakimi M, Windolf J, Jungbluth P
Department of Trauma, Orthopedics and Handsurgery, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351, Berlin, Germany.
Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
Musculoskelet Surg. 2019 Apr;103(1):91-97. doi: 10.1007/s12306-018-0576-2. Epub 2018 Dec 4.
Radial head arthroplasty represents a widely accepted treatment for elbow injuries with non-reconstructible radial head fractures. The aim of this retrospective multicenter study was to assess mid-term results of patients with clearly defined elbow injuries including type III fractures of the radial head according to Mason's classification type III after primary arthroplasty using a cemented bipolar design.
In 45 cases a primary cemented bipolar arthroplasty of the radial head was implanted for elbow injuries combined with an acute Mason type III radial head fracture. In all patients associated fractures were detected with preoperative CT scans and ligamentous injuries were evaluated and both were addressed intraoperatively based on a standardized algorithm. Patients with associated injuries other than coronoid fractures and collateral ligament tears were excluded from this study to obtain a more homogenous sample. Clinical and radiological assessment was performed on thirty-seven patients at an average of 5.6 years postoperatively.
DASH Score, functional rating index of Broberg and Morrey, Mayo Elbow Performance Score, and Mayo Modified Wrist Score confirmed good-to-excellent results in most of the patients. Compared to the unaffected arm range of motion and grip strength were slightly reduced. No elbow instability or loosening of the prosthesis, and minor degenerative changes were detected in a few cases.
Primary cemented bipolar arthroplasty for type III fractures according to Mason's classification in an elbow injury pattern only including associated coronoid fractures and/or ligamentous tears resulted in good-to-excellent mid-term results. These results suggest that primary bipolar radial head arthroplasty combined with distinct treatment of all associated injuries provides good functional outcomes concerning range of motion, elbow stability, and strength in this cohort. However, the associated injuries may influence clinical and radiological outcome and need to be detected, classified, and treated carefully.
桡骨头置换术是治疗不可重建的桡骨头骨折所致肘部损伤的一种广泛接受的治疗方法。这项回顾性多中心研究的目的是评估在使用骨水泥型双极设计进行初次置换术后，患有明确肘部损伤（包括根据梅森分类法III型的桡骨头III型骨折）患者的中期结果。
45例因肘部损伤合并急性梅森III型桡骨头骨折而接受了初次骨水泥型双极桡骨头置换术。所有患者术前均通过CT扫描检测相关骨折，并评估韧带损伤情况，术中均根据标准化算法进行处理。本研究排除了除冠状突骨折和侧副韧带撕裂以外有其他相关损伤的患者，以获得更同质的样本。对37例患者在术后平均5.6年进行了临床和影像学评估。
DASH评分、布罗伯格和莫里功能评分指数、梅奥肘关节功能评分以及梅奥改良腕关节评分证实大多数患者结果良好至优秀。与未受伤的手臂相比，活动范围和握力略有降低。未发现肘关节不稳定或假体松动，少数病例检测到轻微退变改变。
对于仅包括相关冠状突骨折和/或韧带撕裂的肘部损伤模式，根据梅森分类法对III型骨折进行初次骨水泥型双极置换术可获得良好至优秀的中期结果。这些结果表明，初次双极桡骨头置换术结合对所有相关损伤的明确治疗，在该队列中可在活动范围、肘关节稳定性和力量方面提供良好的功能结果。然而，相关损伤可能会影响临床和影像学结果，需要仔细检测、分类和治疗。
