Factor Shai, Gurel Ron, Tordjman Daniel, Eisenberg Gilad, Pritsch Tamir, Rosenblatt Yishai
Hand Surgery Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Pers Med. 2024 Sep 21;14(9):1006. doi: 10.3390/jpm14091006.
Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. : The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants.
梅森3型桡骨头骨折通常采用切开复位内固定术（ORIF）或桡骨头置换术（RHA）进行治疗。假体选项包括传统的一体式植入物和旨在匹配患者解剖结构的新型模块化植入物。虽然金属RHA的短期和中期结果总体良好，但本研究旨在比较接受一体式与模块化植入物治疗患者的长期结果。：回顾性分析了2000年至2011年期间在一级创伤中心接受RHA治疗的所有患者的病历。邀请可进行随访的患者进行重新评估，包括体格检查、评估肘部疼痛和功能的问卷以及随访X光片。在35例接受RHA治疗的患者中，13例（37%）使用一体式假体，22例（63%）使用模块化假体。在可追踪的患者中，一体式组有4例患者和模块化组有10例患者同意参与研究。一体式组的平均随访时间为15年，模块化组为12.4年。与一体式组相比，模块化组的患者表现出更好的功能结果，MEPS和DASH评分有统计学意义的改善，ASES评分和VAS评分有更好的非显著趋势。体格检查显示两组手术侧手臂的功能均下降，在肘部屈伸方面，模块化组有统计学意义的优势。影像学分析显示植入物有不同程度的松动，与一体式组相比，模块化组的松动较少。还观察到轻度退变改变和异位骨化，主要在模块化组。结果表明，与一体式植入物相比，模块化植入物提供了更好的功能结果。模块化组在肘部屈伸方面有统计学意义的改善。这些发现表明，模块化植入物可能是改善患者预后的更有利选择。建议进行更大样本量的进一步研究以证实这些趋势，并更好地了解模块化植入物的长期益处。
