Liu Guanyi, Li Qing, Xu Ding, Zhang Yong, Li Ming, Zhang Long
Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, Zhejiang, China.
Department of Endocrinology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China.
Front Surg. 2025 May 19;12:1506125. doi: 10.3389/fsurg.2025.1506125. eCollection 2025.
The treatment of displaced or comminuted Mason-Johnston type IV radial head fractures is challenging. These fractures often involve complex injuries to the ligaments surrounding the radial head, necessitating careful consideration of treatment strategies that prioritize ligament repair while preserving the integrity of the radial head whenever feasible. The primary objective of this study was to assess the clinical outcomes of open reduction and internal fixation (ORIF) in managing complex radial head fractures associated with transolecranon fractures, Monteggia fractures, and terrible triad injuries.
Between June 2015 and July 2019, twenty patients who underwent ORIF using screws, with or without mini plates, were retrospectively included in the current study to assess the outcomes for Mason-Johnston type IV fractures of the radial head. Based on the initial Mason classification, fourteen fractures were classified as Mason type II, while six were classified as type III. Among these patients, fourteen had terrible triad elbow injuries, three presented with transolecranon fracture and elbow dislocation, two with Monteggia fractures of Bado type II, and one with concomitant fracture of the radial head and elbow dislocation. Both clinical and radiographic evaluations were conducted.
The average duration of follow-up was 31 months, with a range of 24-40 months, and all patients achieved union without any evidence of postsurgical ligamentous instability or failure of internal fixation. The average range of motion for the affected elbow was 136° ± 6° of flexion, 12° ± 6° of extension, 74° ± 10° of pronation, and 67° ± 9° of supination, resulting in a flexion-extension arc of 123° ± 6° and a pronosupination arc of 142° ± 8°. The Broberg and Morrey clinical score averaged 88 ± 8 (range 75-100), with excellent outcomes observed in six patients, good outcomes in ten patients, and fair outcomes in four patients. Three out of 20 patients (15%) exhibited periarticular ossification.
The results of the current study suggest that satisfactory elbow function can be achieved following ORIF for Mason-Johnston type IV fractures of the radial head.
移位或粉碎性的梅森 - 约翰斯顿IV型桡骨头骨折的治疗具有挑战性。这些骨折常常涉及桡骨头周围韧带的复杂损伤，因此在可行的情况下，必须仔细考虑治疗策略，优先进行韧带修复，同时保持桡骨头的完整性。本研究的主要目的是评估切开复位内固定术（ORIF）治疗与经鹰嘴骨折、孟氏骨折和可怕三联征损伤相关的复杂桡骨头骨折的临床疗效。
在2015年6月至2019年7月期间，本研究回顾性纳入了20例行螺钉内固定（有或无微型钢板）的患者，以评估桡骨头梅森 - 约翰斯顿IV型骨折的治疗效果。根据最初的梅森分类，14例骨折为梅森II型，6例为III型。这些患者中，14例患有可怕三联征肘部损伤，3例表现为经鹰嘴骨折并肘关节脱位，2例为巴多II型孟氏骨折，1例伴有桡骨头骨折并肘关节脱位。进行了临床和影像学评估。
平均随访时间为31个月，范围为24 - 40个月，所有患者均实现骨折愈合，且无术后韧带不稳定或内固定失败的迹象。患侧肘关节的平均活动范围为：屈曲136°±6°，伸展12°±6°，旋前74°±10°，旋后67°±9°，屈伸弧为123°±6°，旋前旋后弧为142°±8°。布罗伯格和莫里临床评分平均为88±8（范围75 - 100），6例患者结果为优级，10例为良好，4例为一般。20例患者中有3例（15%）出现关节周围骨化。
本研究结果表明，对于桡骨头梅森 - 约翰斯顿IV型骨折，切开复位内固定术后可获得满意的肘关节功能。
