Lorenz Christina Julia, Carbon Claus-Christian, Meffert Rainer, Eden Lars
Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany; Department of Traumatology, University Hospital Zurich, Zurich, Switzerland.
Department of General Psychology and Methodology, University of Bamberg, Bamberg, Germany.
Injury. 2025 Feb;56(2):111981. doi: 10.1016/j.injury.2024.111981. Epub 2024 Nov 7.
The surgical treatment of radial head fractures like Mason type III comminuted radial head fractures is challenging and controversial. Whether to use open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) as treatment methods is under constant debate.
We retrospectively analyzed clinical and radiographic mid- to long-term results of 42 patients with a mean follow-up time of 4.56 years (1.92-7.58 years). Patients were grouped according to fragment numbers and the type of intervention performed (3-4 fragments vs. 4+ fragments; ORIF vs. RHA). At the final follow-up, range of motion (ROM), functional rating scores and subjective pain and function levels were documented by a blinded outcome assessor.
Although minor differences in the mean values were detected when comparing the results of the functional scores, ROM and subjective pain and function levels, only the movement in pronation and supination direction yielded statistically better results in the group of 4+-fragments for the RHA compared to ORIF. However, the 33 % rate of required implant removal amongst the ORIF group should be considered.
This study provides evidence that 3- and 4-part Mason type III fractures are prone to plate osteosynthesis. In contrast, greater than 4-part fractures can more reliably be treated by replacement. This leads to a proposed increase in fragment numbers to four, where ORIF most likely leads to good clinical results. However, in patients with 4+ fragment patterns, ORIF did not show statistically significantly worse results concerning the collected clinical values. This study supports the use of the ORIF approach to save the radial head.
桡骨头骨折（如梅森III型粉碎性桡骨头骨折）的手术治疗具有挑战性且存在争议。采用切开复位内固定术（ORIF）还是桡骨头置换术（RHA）作为治疗方法一直存在争议。
我们回顾性分析了42例患者的临床和影像学中长期结果，平均随访时间为4.56年（1.92 - 7.58年）。根据骨折块数量和所进行的干预类型（3 - 4块骨折块与4块以上骨折块；ORIF与RHA）对患者进行分组。在末次随访时，由一名不知情的结果评估者记录活动范围（ROM）、功能评分以及主观疼痛和功能水平。
尽管在比较功能评分、ROM以及主观疼痛和功能水平的结果时发现均值存在细微差异，但与ORIF相比，RHA治疗4块以上骨折块组仅在旋前和旋后方向的活动方面取得了统计学上更好的结果。然而，应考虑ORIF组中33%的植入物取出率。
本研究表明，梅森III型3部分和4部分骨折易于采用钢板内固定。相比之下，4部分以上骨折采用置换治疗可能更可靠。这导致建议将骨折块数量增加到4块，此时ORIF最有可能带来良好的临床结果。然而，对于4块以上骨折块类型的患者，就所收集的临床指标而言，ORIF并未显示出在统计学上明显更差的结果。本研究支持采用ORIF方法来保留桡骨头。
