Department of Orthopaedic Surgery, Qingdao University, Qingdao City, 266071, P.R. China.
Department of Bone, Joint and Sports Medicine, East District, Qingdao Municipal Hospital, Qingdao City, 266071, P.R. China.
BMC Musculoskelet Disord. 2021 Jul 9;22(1):613. doi: 10.1186/s12891-021-04498-w.
Management of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, the present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. A hybrid technique combining with intramedullary pining was performed in our study to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails.
The clinical, functional and radiographic outcomes of the groups were compared during follow-up. The radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion (ROM) in the elbow, Visual Analog Scale (VAS) score, Elbow Self-Assessment score (ESAS), Mayo Elbow Performance score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.
Thirteen patients with unstable fractures were participated with an average follow-up of (38.6 ± 4.5) months for the experimental group and (32.0 ± 6.3) months for the control group, respectively. The functional outcomes in the experimental group, including MEPS and DASH, were significantly superior to the control group. However, no significant difference was observed in the elbow ROM and VAS score between two groups. In the last follow-up, one patient with post-traumatic arthritis rated as grades 1 and two with heterotopic ossifications were observed in the experimental group. In the control group, degenerative changes were observed in three cases (grade 1 in two cases and grade 2 in one case) and heterotopic ossifications rated as grade I were found in two patients.
Collectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.
粉碎性桡骨骨折的治疗仍存在争议。目前，桌上重建技术的出现使得粉碎性桡骨颈骨折的固定更加可行。然而，本研究报道了在钢板固定过程中桡骨颈骨折从重建的桡骨头上出现术中不稳定移位的情况，表现为桡骨头与桡骨颈之间的放射状关节头接触不良和不匹配。在我们的研究中，采用髓内钉钉结合混合技术来恢复正常的对线并保持固定的稳定性。因此，本文的目的旨在证明使用钛弹性钉对不稳定粉碎性桡骨颈骨折进行髓外钢板和髓内钉钉固定的可行性。
对两组患者的临床、功能和影像学结果进行随访比较。通过影像学检查评估骨愈合、异位骨化和创伤后关节炎的情况。通过功能评估评估临床效果，包括测量肘部活动范围（ROM）、视觉模拟评分（VAS）、肘部自我评估评分（ESAS）、梅奥肘部功能评分（MEPS）和手臂、肩部和手的残疾（DASH）结果测量评分。
实验组 13 例不稳定骨折患者平均随访（38.6±4.5）个月，对照组平均随访（32.0±6.3）个月。实验组的功能结果，包括 MEPS 和 DASH，明显优于对照组。然而，两组的肘部 ROM 和 VAS 评分无显著差异。末次随访时，实验组 1 例患者出现创伤性关节炎 1 级，2 例患者出现异位骨化；对照组中，3 例患者出现退行性改变（2 例 1 级，1 例 2 级），2 例患者出现 1 级异位骨化。
综上所述，髓内钉钉联合髓外钢板固定不稳定粉碎性桡骨颈骨折是可行的，可作为桌上重建技术的补救手术。
