Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital.
Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Medicine (Baltimore). 2021 Jan 22;100(3):e24036. doi: 10.1097/MD.0000000000024036.
Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as 'radius bipolar fracture'. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital.
Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling.
Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture.
In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture.
Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively.
After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.
伴有同侧桡骨小头骨折的桡骨远端骨折是一种非常罕见的损伤类型。这种类型的损伤被称为“桡骨双极骨折”。由于需要同时考虑腕关节和肘关节，这种损伤类型的治疗具有挑战性。目前尚无针对这种特定类型损伤的治疗指南。我们报告了在我院治疗的两例这种不常见损伤类型的病例。
病例 1 为 78 岁女性患者，病例 2 为 19 岁女性患者，两人均因滑倒摔伤后来我院急诊就诊，诉左肘部和腕部疼痛。
X 线和 CT 显示桡骨双极骨折。病例 1 为桡骨远端 AO 分型 C3 型骨折、Mason Ⅲ型桡骨小头骨折；病例 2 为桡骨远端 AO 分型 B2 型无移位骨折、Mason Ⅲ型桡骨小头骨折。
病例 1 行桡骨远端切开复位内固定术（ORIF）和桡骨小头置换术；病例 2 行保守治疗桡骨远端骨折，行桡骨小头 ORIF。
两例患者均获得骨性愈合。病例 1 随访 1 年时腕关节活动度略受限；病例 2 未见桡骨短缩，腕关节和肘关节活动度完全正常。患者的残疾程度（DASH）评分为 18 分和 16 分。
这种损伤后桡骨长度可能会发生变化，从而影响尺侧骨间距离。如果考虑行桡骨小头置换术，最好先进行腕关节手术，然后再进行桡骨小头置换术，以防止桡尺骨头过度填充或不稳定。但是，如果计划对桡骨近端骨折行 ORIF，可先固定近端或远端桡骨。治疗过程中，术者应尽量保留桡骨长度，以优化患者预后。
