Park Il-Jung, Roh Youn-Tae, Shin Seung-Han, Park Ho-Yeon, Jeong Changhoon, Kang Soo-Hwan
Department of Orthopedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopedic Surgery, H Plus Yangji Hospital, Seoul, Korea.
Acta Orthop Traumatol Turc. 2021 Mar;55(2):112-117. doi: 10.5152/j.aott.2021.20046.
This study aimed to analyze the injury pattern and clinical importance of concomitant capitellar cartilage defects (CCDs) among patients treated surgically for radial head fracture (RHF).
A total of 74 patients who were treated surgically for isolated RHFs were retrospectively reviewed. Of these, 12 patients with CCDs (16.2%) were classified as Group I (10 men; mean age, 41.3±12.8 years) and the remaining 62 patients without CCD as Group II (control group) (48 men; mean age, 50.8±13 years). The mean follow-up was 21.3±3.2 months in Group I and 18.7±6.4 in Group II. In Group I, 11 patients underwent open reduction and internal fixation, whereas 1 patient was treated by radial head resection. The preoperative range of motion (ROM) was recorded; the severity of RHF was assessed using the Mason classification. The location, size, and thickness of CCD injuries at the time of surgery were also documented. At the final follow-up, radiological assessment was performed to determine the bone union, and clinical measurements, including ROM and the Mayo elbow performance score (MEPS), were performed. The clinical features of the 2 groups were statistically analyzed.
In Group I, 10 patients showed limited forearm rotation. CCD was located posterolaterally in 11 patients and anterolaterally in 1 patient. At the final follow-up, 11 patients from Group I who underwent open reduction and internal fixation showed complete union of RHF and full recovery of pronation and supination. According to the MEPS, 9 patients exhibited excellent results, and 3 patients exhibited good results. In Group I, RHFs were classified as Mason type II in 7 patients (58.3%) and type III in 4 patients (58.3%). In Group II, RHFs were type II in 45 patients (72.6%) and type III in 17 patients (27.4%). In comparative analyses, there was a significant difference in age (41.3±12.8 versus 50.8±13.0, p=0.041) between the 2 groups. Preoperative pronation/supination was higher in Group II (131.7±36.2) than in Group I (106.3±31.6) (p=0.021). There were no significant differences in sex (p=0.097), follow-up period (p=0.326), Mason type (p=0.482), preoperative extension/flexion (102.3±43.3 [Group I] versus 107.6±44.9 [Group II]) (p=0.584), final follow-up extension/flexion (133.3±10.7 [Group I] versus 126.9±21.2 [Group II]) (p=0.384), pronation/supination (151.2±9.1 [Group I] versus 151.2±13.3 [Group II]) (p=0.558), and the MEPSs (92.9±6.6 [Group I] versus 93.3±7.5 [Group II]) (p=0.701).
If a thorough physical examination of a patient with RHF reveals limited forearm rotation, effort must be made to identify the cause, and the possibility of CCD must be considered. Moreover, there is a need for careful observation during RHF surgery for not only fracture reduction or fixation but also possible CCD.
Level III, Therapeutic Study.
本研究旨在分析桡骨头骨折（RHF）手术治疗患者中合并的肱骨小头软骨缺损（CCD）的损伤模式及临床重要性。
回顾性分析74例接受孤立性RHF手术治疗的患者。其中，12例合并CCD的患者（16.2%）被归为I组（10例男性；平均年龄41.3±12.8岁），其余62例无CCD的患者作为II组（对照组）（48例男性；平均年龄50.8±13岁）。I组平均随访时间为21.3±3.2个月，II组为18.7±6.4个月。I组中，11例患者接受切开复位内固定术，1例患者接受桡骨头切除术。记录术前活动范围（ROM）；采用Mason分类法评估RHF的严重程度。还记录了手术时CCD损伤的位置、大小和厚度。在末次随访时，进行影像学评估以确定骨愈合情况，并进行临床测量，包括ROM和梅奥肘关节功能评分（MEPS）。对两组的临床特征进行统计学分析。
I组中，10例患者前臂旋转受限。11例患者的CCD位于后外侧，1例位于前外侧。在末次随访时，I组中接受切开复位内固定术的11例患者RHF完全愈合，旋前和旋后功能完全恢复。根据MEPS，9例患者结果为优，3例患者结果为良。I组中，7例（58.3%）RHF被分类为Mason II型，4例（58.3%）为III型。II组中，45例（72.6%）RHF为II型，17例（27.4%）为III型。在比较分析中，两组间年龄存在显著差异（41.3±12.8对50.8±13.0，p = 0.041）。II组术前旋前/旋后角度（131.7±36.2）高于I组（106.3±31.6）（p = 0.021）。在性别（p = 0.097）、随访时间（p = 0.326）、Mason分型（p = 0.482）、术前伸展/屈曲角度（I组102.3±43.3对II组107.6±44.9）（p = 0.584）、末次随访伸展/屈曲角度（I组133.3±10.7对II组126.9±21.2）（p = 0.384）、旋前/旋后角度（I组151.2±9.1对II组151.2±13.3）（p = 0.558）以及MEPS评分（I组92.9±6.6对II组93.3±7.5）（p = 0.701）方面，两组间均无显著差异。
如果对RHF患者进行全面体格检查发现前臂旋转受限，必须努力找出原因，并考虑存在CCD的可能性。此外，在RHF手术过程中，不仅要仔细观察骨折复位或固定情况，还要注意可能存在的CCD。
III级，治疗性研究。
