Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany.
Bone Joint J. 2024 Oct 1;106-B(10):1158-1164. doi: 10.1302/0301-620X.106B10.BJJ-2024-0407.R1.
The aim of this study was to evaluate the outcome of complex radial head fractures at mid-term follow-up, and determine whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) should be recommended for surgical treatment.
Patients who underwent surgery for complex radial head fractures (Mason type III, ≥ three fragments) were divided into two groups (ORIF and RHA) and propensity score matching was used to individually match patients based on patient characteristics. Ultimately, 84 patients were included in this study. After a mean follow-up of 4.1 years (2.0 to 9.5), patients were invited for clinical and radiological assessment. The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score were evaluated.
Patients treated with ORIF showed significantly better postoperative range of motion for flexion and extension (121.1° (SD 16.4°) vs 108.1° (SD 25.8°); p = 0.018). Postoperative functional scores also showed significantly better results in the ORIF group (MEPS 90.1 (SD 13.6) vs 78 (SD 20.5); p = 0.004). There was no significant difference between the groups in terms of the complication rate (RHA 23.8% (n = 10) vs ORIF 26.2% (n = 11)). Implant-related complications occurred in six cases (14.3%) in the RHA group and in five cases (11.9%) in the ORIF group.
Irrespective of the patient's age, sex, type of injury, or number of fracture fragments, ORIF of the radial head should be attempted initially, if a stable reconstruction can be achieved, as it seems to provide a superior postoperative outcome for the patient compared to primary RHA. If reconstruction is not feasible, RHA is still a viable alternative. In the surgical treatment of complex radial head fractures, reconstruction shows superior postoperative outcomes compared to RHA. Good postoperative results can be achieved even after failed reconstruction and conversion to secondary RHA. Therefore, we encourage surgeons to favour reconstruction of complex radial head fractures, regardless of injury type or number of fragments, as long as a stable fixation can be achieved.
本研究旨在评估中期随访时复杂桡骨头骨折的治疗结果，并确定切开复位内固定（ORIF）或桡骨头置换（RHA）是否应作为手术治疗的推荐方法。
将接受手术治疗的复杂桡骨头骨折（Mason Ⅲ型，≥3 块骨折）患者分为两组（ORIF 和 RHA），并根据患者特征进行个体匹配。最终，本研究纳入 84 例患者。平均随访 4.1 年后（2.0 至 9.5 年），邀请患者进行临床和影像学评估。采用 Mayo 肘功能评分（MEPS）、牛津肘评分（OES）和上肢残障问卷（DASH）评分评估患者的功能。
ORIF 组患者术后屈伸活动度明显更好（121.1°（SD 16.4°）比 108.1°（SD 25.8°）；p = 0.018）。ORIF 组术后功能评分也明显更好（MEPS 90.1（SD 13.6）比 78（SD 20.5）；p = 0.004）。两组并发症发生率无显著差异（RHA 23.8%（n = 10）与 ORIF 26.2%（n = 11））。RHA 组发生 6 例（14.3%）与 ORIF 组发生 5 例（11.9%）与植入物相关的并发症。
无论患者的年龄、性别、损伤类型或骨折块数量如何，如果能够实现稳定的重建，都应首先尝试桡骨头 ORIF，如果可行，与初次 RHA 相比，似乎能为患者提供更好的术后结果。如果重建不可行，RHA 仍然是一种可行的选择。在复杂桡骨头骨折的手术治疗中，重建的术后结果优于 RHA。即使重建失败并转为二次 RHA，也能取得良好的术后结果。因此，我们鼓励外科医生在可行的情况下，优先选择重建复杂桡骨头骨折，无论损伤类型或骨折块数量如何，只要能够实现稳定固定。
