Heim U, Trüb H J
Helv Chir Acta. 1978 May;45(1-2):63-9.
Displaced fractures of the radial head are indications for early surgery. The resection is unsatisfactorily leading often to an instable elbow in valgus deformity and to painful troubles in the distal radio ulnar joint. Prosthesis implantation has its own problems. Reconstructive surgery is obviously the best solution. 21 internal fixations in 20 patients were performed using small screws (and 2 plates) between 1968 and 1976. The functional and radiological results are excellent in 15 out of 19 controlled patients. 3 patients have a moderate reduction of the mobility, 1 patient a non-union. -We were impressed by 4 operative observations: The fractures and the displacements use to be unexpectedly important. There is usually a periostal bridge between the head fragments and the neck. That is why complete devitalization of the articular fragments is rare. In about half of our cases we found an important avulsion of the humeral articular cartilage. In 8 of 10 cases these avulsions were interposed in the fragments of the radius. Their removal is necessary for the reduction. -These observations should influence the indication for reconstructive surgery in fractures of the radial head.
桡骨头移位骨折是早期手术的指征。切除术往往效果不佳，常导致肘关节外翻畸形不稳定以及桡尺远侧关节疼痛问题。假体植入也有其自身问题。显然，重建手术是最佳解决方案。1968年至1976年间，对20例患者进行了21次内固定，使用小螺钉（和2块钢板）。19例接受随访的患者中，15例功能和影像学结果极佳。3例患者活动度有中度降低，1例患者出现骨不连。我们对4项手术观察印象深刻：骨折和移位通常出乎意料地严重。头碎片与颈部之间通常有骨膜桥。这就是关节碎片完全失活很少见的原因。在我们大约一半的病例中，发现肱骨关节软骨有重要的撕脱。在10例病例中的8例中，这些撕脱位于桡骨碎片之间。为了复位，必须将其去除。这些观察结果应影响桡骨头骨折重建手术的指征。
