Clinical Efficacy Of Non-reducible Comminuted Fracture Of Radial Head Was Reconstructed By Autogenous Iliac Crest

Objective:To investigate the effect of iliac crest autograft in the reconstruction of non-reducible comminuted fracture of radial head.Methods:Twenty-seven patients with type MasonⅢ and type Ⅳ comminuted radial head fractures who received treatment in the Department of Orthopedics and Trauma of the Second People’s Hospital of Yunnan Province from June 2016 to June 2019 were selected as the study subjects.All patients were treated by the surgical method of autologous iliac crest reconstruction of the radial head.The patients were followed up at 1,3,6 and 12 months after surgery,and the recovery degree of the patients after elbow treatment was evaluated by X-ray film,modified Broberg-Morrey elbow function scale,DASH upper limb function scale and other indicators.At each follow-up,the elbow range of motion of the healthy limb and the affected limb of the same patient was measured,and the two groups of data were compared and statistically processed using the statistical method of t-test with two independent samples.Results:Radiographs showed that 25 radial heads were bony healed after autogenous iliac crest reconstruction.The bony healing rate was 92.6%,and the healing time was 10-14 weeks,with an average of(11.35±1.15)weeks.Nonunion with iliac graft resorption occurred in 2 cases.The internal fixation devices of all patients were stable,and no signs of loosening and breaking were found.The stability of the elbow joint reached the normal range,and the function of the elbow joint recovered significantly compared with that before operation.At the last follow-up,according to the Broberg-Morrey elbow function scale,21 cases were excellent,3 cases were good,2 cases were fair,and 1 case was poor.The overall excellent and good rate was 88.9%.The average score of DASH upper limb function was(15.36±5.33).Follow-up at 1,3,6 and 12 months after surgery showed significant differences in flexion and extension,pronation and supination of the elbow on the affected side compared with that on the healthy side(P<0.05).The results of the last follow-up showed that there was no significant difference in the flexion and extension and pronation activity of the elbow between the affected side and the healthy side,while there was a significant difference in the supination activity of the elbow between the affected side and the healthy side(P<0.05).Conclusion:It achieved good clinical results in a short period of time that the non-reducible comminuted fracture of radial head was reconstructed by autogenous iliac crest.If the transplant of bone can reach the standard clinical fracture healing,this surgical procedure can relieve elbow pain,improve elbow function and maintain elbow stability,at the same time to preserve the structural integrity of the elbow joint.It avoids the problem of prosthesis revision and other secondary operations,which is worthy of clinical promotion.However,the number of cases involved in this study was small,the follow-up time was short,and the long-term efficacy needed to be further studied.