Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
J Shoulder Elbow Surg. 2019 Aug;28(8):1457-1467. doi: 10.1016/j.jse.2018.11.047. Epub 2019 Feb 1.
Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures.
This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22.8%, Mason type IV fracture in 20.9%, terrible-triad injury in 12.8%, Monteggia-like lesion in 13.1%, and Essex-Lopresti lesion in 2.0%. Initial treatment was nonoperative in 30.2%, open reduction and internal fixation (ORIF) in 44.9%, radial head arthroplasty in 16.6%, radial head resection in 3.7%, sole treatment of concomitant injuries in 2.6%, and fragment excision in 2.0%. Up to 3 revision causes and procedures were recorded per case.
The most common complications were stiffness (67.4%), instability (36.5%), painful osteoarthritis (29.2%), ORIF related (14.8%), nonunion or necrosis (9.2%), radial head arthroplasty related (7.5%), ulnar neuropathy (6.0%), and infection (2.6%). Revision procedures frequently included arthrolysis (42.1%), arthroplasty (24.9%), implant removal (23.6%), ligament repair or reconstruction (23.0%), débridement (14.2%), repeated ORIF (8.2%), and/or radial head resection (7.7%). Mason type I or II fractures were primarily revised because of stiffness and painful osteoarthritis. Complications after Mason type III fractures were predominantly ORIF related. Fracture-dislocations showed a wide range of complications, with instability and stiffness comprising the most common causes of revision.
The complications of radial head fractures are characteristic to their classification. Knowledge of these findings might guide surgeons in treating these injuries and may help counsel patients accordingly.
桡骨头骨折在相当数量的病例中导致持续残疾。本研究旨在探讨其最常见的翻修原因和手术方式。
这项多中心回顾性研究回顾了 466 例成年患者的病例，这些患者在桡骨头骨折的手术或非手术治疗后接受了手术翻修。初始诊断为 Mason Ⅰ型骨折 13.0%，Mason Ⅱ型骨折 14.6%，Mason Ⅲ型骨折 22.8%，Mason Ⅳ型骨折 20.9%，三联征损伤 12.8%，类似孟氏骨折损伤 13.1%，Essex-Lopresti 损伤 2.0%。初始治疗为非手术治疗 30.2%，切开复位内固定（ORIF）治疗 44.9%，桡骨头置换术治疗 16.6%，桡骨头切除术治疗 3.7%，单独治疗伴随损伤 2.6%，骨块切除术治疗 2.0%。每个病例记录了多达 3 种翻修原因和手术方式。
最常见的并发症是僵硬（67.4%）、不稳定（36.5%）、疼痛性骨关节炎（29.2%）、与 ORIF 相关（14.8%）、骨不连或坏死（9.2%）、桡骨头置换术相关（7.5%）、尺神经病变（6.0%）和感染（2.6%）。翻修手术常包括关节松解术（42.1%）、关节置换术（24.9%）、植入物取出术（23.6%）、韧带修复或重建术（23.0%）、清创术（14.2%）、再次 ORIF 治疗（8.2%）和/或桡骨头切除术（7.7%）。Mason Ⅰ或Ⅱ型骨折主要因僵硬和疼痛性骨关节炎而进行翻修。Mason Ⅲ型骨折的并发症主要与 ORIF 相关。骨折脱位表现出广泛的并发症，不稳定和僵硬是翻修的最常见原因。
桡骨头骨折的并发症与其分类有关。了解这些发现可能有助于指导外科医生治疗这些损伤，并相应地为患者提供咨询。
