Kumar Prasoon, Jindal Karan, Rajnish Rajesh Kumar, Patel Sandeep, Sharma Siddhartha, Kumar Vishal, Aggarwal Sameer
Department of Orthopaedics, PGIMER, Chandigarh, India.
Department of Orthopaedics, Adesh Medical College and Hospital, Shahabad, Kurukshetra, Haryana 136135 India.
Indian J Orthop. 2022 Jun 20;56(8):1305-1315. doi: 10.1007/s43465-022-00645-0. eCollection 2022 Aug.
The radial head fractures comprise approximately 4% of all fractures around the elbow. The outcomes of open reduction and internal fixation are poor in fractures with more than three fragments, and the excision of radial head is considered a viable surgical treatment option. However, it is associated with its own set of complications. The radial head prosthetic replacement has emerged as an alternative in management of these fractures with constraints of cost and related complications. Hence, the treatment for the unrepairable comminuted radial head fractures still remains controversial.
This systematic review and meta-analysis was conducted to compare the post-operative outcomes of the radial head excision versus prosthetic replacement in comminuted Mason type-III fractures of radial head.
Three databases of Medline (PubMed), Scopus, and Embase were searched for comparative studies on the study question and relevant studies which mentioned at least one of the outcomes of interest (functional outcome scores and number of complications) were included.
Six studies were part of this review with 82 excisions and 99 prosthetic replacements. There was no significant difference between the two groups in terms of number of complications (OR 0.65; 0.08-5.07); and measures of functional outcomes; Mayo elbow performance score or MEPS (mean difference - 6.56; - 23.45 to 10.33). The incidence of elbow osteoarthritis, heterotrophic ossification, stiffness, and instability were similar in both groups. The flexion extension arc in degrees was better in excision group (mean difference 9.93; 1.31-18.55; = .02).
Excision is a reasonable surgical option for isolated comminuted radial head fractures with similar results of function and associated rates of complications as prosthetic replacements. The arc of motion is also better with excisions. There have been reports of more osteoarthritis with excision and arthroplasty has been advised in younger patients; however, we had no quantitative proof of that in this review.
桡骨头骨折约占肘部周围所有骨折的4%。对于骨折块超过三块的骨折，切开复位内固定的效果较差，桡骨头切除术被认为是一种可行的手术治疗选择。然而，它也有自身的一系列并发症。桡骨头假体置换已成为治疗这些骨折的一种替代方法，但存在成本和相关并发症的限制。因此，对于无法修复的粉碎性桡骨头骨折的治疗仍存在争议。
本系统评价和荟萃分析旨在比较桡骨头切除术与假体置换术治疗桡骨头粉碎性梅森III型骨折的术后效果。
检索了Medline（PubMed）、Scopus和Embase三个数据库，查找关于该研究问题的比较研究，并纳入至少提及一项感兴趣结果（功能结局评分和并发症数量）的相关研究。
六项研究纳入本评价，其中82例为切除术，99例为假体置换术。两组在并发症数量（比值比0.65；0.08 - 5.07）和功能结局指标（梅奥肘关节功能评分或MEPS，平均差值 - 6.56； - 23.45至10.33）方面无显著差异。两组肘关节骨关节炎、异位骨化、僵硬和不稳定的发生率相似。切除术组的屈伸弧度度数更好（平均差值9.93；1.31 - 18.55；P = 0.02）。
对于孤立的粉碎性桡骨头骨折，切除术是一种合理的手术选择，其功能结果和并发症发生率与假体置换术相似。切除术的活动弧度也更好。有报道称切除术导致更多骨关节炎，因此建议年轻患者行关节成形术；然而，在本评价中我们没有定量证据支持这一点。
