Department of orthopedic, the University-town Hospital of Chongqing Medical University, China.
Department of orthopedic, the University-town Hospital of Chongqing Medical University, China.
Injury. 2020 Oct;51(10):2253-2258. doi: 10.1016/j.injury.2020.07.041. Epub 2020 Jul 19.
The treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation with metallic plates and screws are hard to achieve. Conventional techniques include radial head resection and arthroplasty. Both methods have inevitable complications. The purpose of this retrospective study is to prove the feasibility of treating unsalvageable radial head fractures with absorbable polylactide pins.
A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic plates and screws. Patients receiving both modalities were followed-up for a mean of 24 months (standard deviation SD: 2.6). Radiographic analysis was conducted 2, 30, 60, and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score, and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test.
By the time of last follow up, All fractures in both groups healed successfully. The duration (134 min SD:21 min to 131 min SD:19 min) and blood loss (121 ml SD: 25 ml to 124 ml SD: 27 ml) during surgery of polylactide pin and metallic implant group have no statistical differences. The MEPI score (91 SD:7 to 94 SD:9), the Broberg and Morrey score (93 SD:3 to 93 SD:5), the DASH outcome measures (4.5 SD: 3.0 to 3.7 SD: 3.5), the range of motion also shows no statistical differences. Complications were infrequent and did not cause disability in both groups. All patients were satisfied with the surgical outcomes.
Polylactide pins can feasibly treat severely comminuted radial head fractures, which usually are considered unreducible. This technique provides an optional treatment plan in addition to resection or arthroplasty, especially for young patients that refuse that form of treatment.
粉碎性、不可挽救的桡骨头骨折的治疗仍存在争议。切开复位内固定金属板和螺钉难以实现。传统技术包括桡骨头切除和关节成形术。这两种方法都有不可避免的并发症。本回顾性研究的目的是证明可吸收聚乳酸钉治疗不可挽救的桡骨头骨折的可行性。
共 17 例严重粉碎性 Mason Ⅲ型桡骨头骨折患者采用聚乳酸钉切开复位内固定治疗，23 例采用金属板和螺钉治疗。两种方法均随访平均 24 个月（标准差 SD：2.6）。术后 2、30、60 和 120 天进行影像学分析。记录关节活动度（ROM）、手臂肩部和手部残疾、Mayo 肘功能评分和 Broberg 和 Morrey 肘评分，并采用 Mann-Whitney U 检验比较治疗效果。
末次随访时，两组所有骨折均愈合良好。聚乳酸钉和金属植入组手术时间（134min SD：21min-131min SD：19min）和出血量（121ml SD：25ml-124ml SD：27ml）无统计学差异。MEPI 评分（91 SD：7-94 SD：9）、Broberg 和 Morrey 评分（93 SD：3-93 SD：5）、DASH 结果测量（4.5 SD：3.0-3.7 SD：3.5）、关节活动度也无统计学差异。两组并发症均不常见，且不引起残疾。所有患者对手术结果均满意。
聚乳酸钉可治疗通常认为不可复位的严重粉碎性桡骨头骨折。这种技术为切除或关节成形术提供了一种可选的治疗方案，特别是对于拒绝这种治疗方式的年轻患者。
