Kaeppler Kathrin, Geissbuhler Annabel R, Rutledge Joan C, Dornan Grant J, Wallace Conor A, Viola Randall W
Steadman Philippon Research Institute, Vail, CO, USA.
The Steadman-Hawkins Clinic, Vail, CO, USA.
J Shoulder Elbow Surg. 2025 Feb;34(2):531-542. doi: 10.1016/j.jse.2024.07.022. Epub 2024 Sep 1.
The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. The purpose of this study was to report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up.
All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome questionnaires were administered at the time of last clinical follow-up and at a minimum of 10 years postoperatively.
Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three nonunions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139°, average extension was 4°, average supination was 77°, and average pronation was 81°. The median Disabilities of the Arm, Shoulder and Hand score was 7 (ranging from 0 to 32). Minimum 10-year follow-up (mean: 14.6 years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10 years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10 of 10 (range: 3-10).
ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6 years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes.
复杂桡骨头骨折的治疗仍存在争议，切开复位内固定（ORIF）、桡骨头置换术和桡骨头切除术是最常见的治疗选择。虽然ORIF是Mason II型骨折的首选治疗策略，但Mason III型骨折的最佳治疗方法仍存在争议。本研究的目的是报告Mason II型和III型桡骨头骨折ORIF术后至少10年的结果。我们假设Mason II型和III型骨折患者在至少10年的随访中都将表现出满意的临床结果。
纳入2005年至2010年间由单一外科医生进行ORIF治疗的所有Mason II型或III型桡骨头骨折患者。有明显骨缺损的骨折采用植骨治疗，肘部韧带损伤采用一期韧带修复或重建治疗。在最后一次临床随访时和术后至少10年时进行患者报告结局问卷调查。
24例患者符合纳入标准，其中男性13例，女性11例，手术时平均年龄39岁（范围19 - 60岁）。13例患者为Mason II型骨折，11例患者为Mason III型骨折。在初次随访时，24例骨折中有21例（88%）显示影像学愈合。3例骨不连，其中2例为Mason III型骨折，采用ORIF翻修术和髂嵴植骨治疗。11例患者出现术后肘关节僵硬，需要进行关节囊松解手术。在最后一次临床随访时，平均屈曲角度为139°，平均伸展角度为4°，平均旋后角度为77°，平均旋前角度为81°。手臂、肩部和手部功能障碍评分中位数为7分（范围0至32分）。24例患者中的18例（75%）进行了至少10年的随访（平均：14.6年）。术后至少10年时，QuickDASH评分中位数为4.5分（范围：0至25分），SANE评分中位数为96.5分（范围：75 - 100分）。手术结果的满意度中位数为满分10分中的10分（范围：3 - 10分）。
Mason II型和III型桡骨头骨折的ORIF术后平均14.6年的愈合率高，功能结果良好。研究结果表明，Mason II型和III型桡骨头骨折的ORIF可带来长期积极的功能结果。
