| Objective: To compare the short-term curative effects of open reduction internal fixation and radial head prosthesis replacement in the treatment of radial head fractures with different fracture fragments.Methods: The clinical data of 78 cases of radial head fractures patients were statistically analyzed from May 2010 to August 2015.According to the preoperative imaging data and operation record,the number of radial head fractures was determined.78 cases of patients were randomly divided into two groups on the basis of different fracture fragments(A: the fracture fragments less than or equal to 3 and B: the fracture fragments greater than 3).According to the operation method,A and B were divided into two subgroups."1" was the internal fixation group(i.e.,A1 and B1),and "2" was the prosthesis replacement group(i.e.,A2,B2 group).The postoperative indexes of A and B in each group were assessed,to compare the curative effects of open reduction internal fixation and radial head prosthesis replacement in the treatment of radial head fractures with different fracture fragments.For more details,please refer to the following.There were 40 cases of patients in group A.The number of radial head fractures was ≤3.There were 22 cases in group A1,including 6 cases with 2 fracture fragments and 16 cases with 3 fracture fragments.The patients in group A1 underwent open reduction internal fixation,including 10 males and 12 females,the average age was 35.5(20-61)years old.All the patients suffered from the unilateral fractures,including 9 cases of left fracture and 13 cases of right fracture.According to the modified Mason classification,14 cases belonged to type III and 8 cases belonged to type IV.The fracture reasons included 15 cases of falling injury,2 cases of high falling accident,2 cases of car accident and 3 cases of other.The concomitant injury included 8 cases of elbow joint dislocation,4 cases of medial collateral ligament injury,5 cases of lateral collateral ligament injury and 3 cases of ulnar coronoid process fracture.The average time from injury to operation was 2.5(1-5)days.There were 18 cases in group A2,including 4 cases with 2 fracture fragments and 14 cases with 3 fracture fragments.The patients in group A2 underwent radial head prosthesis replacement.There were 8 males and 10 females.The average age was 37.5(21-65)years old.All the patients suffered from the unilateral fractures,including 7 cases of left fractures and 11 cases of right fractures.According to the modified Mason classification,12 cases belonged to type III and 6 cases belonged to type IV.The fracture reasons included 13 cases of falling injury,2 cases of high falling accident,1 case of car accident and 3 cases of other.The concomitant injury included 6 cases of elbow joint dislocation,3 cases of medial collateral ligament injury,4 cases of lateral collateral ligament injury and 2 cases of ulnar coronoid process fracture.The average time from injury to operation was 2(1-4)days.There were 38 cases of patients in group B.The number of radial head fractures was ≤3.There were 18 cases in group B1,including 11 cases with 4 fracture fragments and 7 cases with ≥5 fracture fragments.The patients in group B1 underwent open reduction internal fixation,including 8 males and 10 females.The average age was 34.5(20-58)years old.All the patients suffered from the unilateral fractures,including 7 cases of left fracture and 11 cases of right fracture.According to the modified Mason classification,12 cases belonged to type III and 6 cases belonged to type IV.The fracture reasons included 12 cases of falling injury,2 cases of high falling accident,2 cases of car accident and 2 cases of other.The concomitant injury included 6 cases of elbow joint dislocation,4 cases of medial collateral ligament injury,3 cases of lateral collateral ligament injury and 3 cases of ulnar coronoid process fracture.The average time from injury to operation was 3(1-6)days.There were 20 cases in group B2,including 11 cases with 4 fracture fragments and 9 cases with ≥5 fracture fragments.The patients in group B2 underwent radial head prosthesis replacement.There were 9 males and 11 females.The average age was 36.5(21-64)years old.All the patients suffered from the unilateral fractures,including 8 cases of left fracture and 12 cases of right fracture.According to the modified Mason classification,there were 12 cases belonged to type III and 8 cases belonged to type IV.The fracture reasons included 12 cases of falling injury,2 cases of high falling accident,3 case of car accident and 3 cases of other.The concomitant injury included 8 cases of elbow joint dislocation,4 cases of medial collateral ligament injury,4 cases of lateral collateral ligament injury and 2 cases of ulnar coronoid process fracture.The average time from injury to operation was 2.5(1-4)days.All patients in group A and B accorded with the diagnostic criteria of radial head fractures.They had specific surgery indications.The fracture fragments,fracture reasons,fracture type and other general clinical data showed no statistical difference between all groups(P>0.05).The operations were completed by the same group of doctors.The increase of carrying angle and radial proximal displacement were measured according to the follow-up elbow joint X-ray film.The fracture healing and related complications were observed.The flexion and extension of the elbow joint and forearm rotation activity were measured.The elbow joint pain was evaluated by visual analogue pain score(VAS)using face-to-face questionnaire or telephone follow-up;The overall treatment was assessed using the Mayo elbow function score.Results: 78 cases of patients in group A and B were followed up.The average follow-up time was 27.5(12-43)months.Group A: 1 case occurred to heterotopic ossification and 1 case occurred to traumatic arthritis in group A1;1 case occurred to heterotopic ossification in group A2.Other patients had no complication.The elbow pain score(VAS),forearm rotation,elbow flexion degree,flexion and extension degree and radial proximal displacement showed no statistical difference between group A1 and group A2(P>0.05);The extension deletion and carrying angel of elbow showed statistical difference between group A1 and group A2(P<0.05).The group A2 was superior to group A1.However,the two had no significant difference in the Mayo Elbow function score(P>0.05).Group B: 1 case occurred to fracture nonunion,1 case occurred to heterotopic ossification and 1 cases occurred to traumatic arthritis in group B1;1 case occurred to traumatic arthritis and 1 cases occurred to heterotopic ossification in group B2.The VAS scores showed no statistical difference between group B1 and group B2(P>0.05);The increase of carrying angel,elbow activity,forearm rotation and radial proximal displacement in group B2 were superior to those of group B1.The difference was statistically significant(P<0.05).The Mayo elbow function score was(70.96±9.24)in group B1 and(85.51±10.46)in group B2.And the difference was statistically significant(P<0.05).The group B2 was superior to group B1.There were 10 excellent cases,7 good cases,2 normal cases and 1 poor case in group B2.The excellent and good rate was 85.0%.There were 7 excellent cases,4 good cases,5 normal cases and 2 poor cases in group B2.The excellent and good rate was 61.1%.Conclusion: This study showed that as for Mason-Johnston type III and IV radial head fractures,when the fracture fragments were ≤3,the therapeutic effects of prosthesis replacement and open reduction internal fixation were comparative;When the fracture fragments were ≥3,the therapeutic effect of the former was obviously superior to that of the latter. |
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