| Objective: Comparison of the clinical efficacy and safety of different internal fixation elbow anterior approach and Kocher approach in the treatment of Mason II/III radial head fracture.Methods: A total of 50 patients with Mason II/III radial head fracture admitted from March 2018 to March 2022 were retrospectively analyzed.They were divided into group A and group B according to different surgical incision approaches,and then divided into group A1 according to different internal fixation methods:12 cases(6males and 6 females)were treated with compression cannulated screw fixation through anterior elbow approach.The age range is 23-47 years,with an average age of:32.58± 7.18,8/4 cases of Mason II/III.Group A2: 11 cases(7 males and 4 females,aged 23-39 years,with a mean age of 31.00±5.85 years)received locking plate internal fixation via anterior elbow approach.6/5 cases were Mason II/III type.Group A3: radial head replacement via antecubital approach,1 case,male,51 years old,Mason type III radial head fracture.Group B1: cannulated screw fixation via Kocher approach,13 cases,including 8 males and 5 females,aged 21-53 years,with a mean age of 35.00±11.48,and 10/3 cases of Mason II/III.Group B2: Kocher approach locking plate fixation,12 cases,including 6 males and 6 females,aged 21-53 years,with a mean age of 35.33±7.62 years,and 5/7 cases of Mason II/III type.Group B3:Kocher approach radial head replacement,1 case,male,49 years old,Mason III type.The data of general,peri-operative,imaging and regular follow-up were collected and recorded in detail.The Mayo elbow function score system was used to evaluate the elbow function.All the data were analyzed by IBM SPSS Statistics 25.0.Results: All patients in each group received complete follow-up after surgery,and no incision infection,nerve injury symptoms,etc.occurred.During the follow-up period,no complications such as internal fixation failure,fracture nonunion or malunion occurred.Group A1(18.75±7.11)had less hemorrhagic volume than Group B1(27.20±7.53);Group A1(48.25±9.13)had less operation time than Group B1(63.92±10.91);Group A1(5.41±0.41)had less incision length than Group B1(7.08±0.49),and the differences had statistical significance(P<0.05).Group A2(25.90±7.69)had less hemorrhagic volume than Group B2(36.66±19,30),shorter operation time than Group B2(75.00±15.37),and shorter incision length than Group B2(7.23±0.68).The differences were statistically significant(P<0.05).There was no statistically significant difference in VAS score on postoperative day 1,elbow flexion range of motion,pronation and supination angle and Mayo elbow function score between group A1 and group B1 at the last follow-up(P>0.05);there was no statistically significant difference in VAS score on postoperative day 1,elbow flexion range of motion,pronation and supination angle and Mayo elbow function score between group A2 and group B2 at the last follow-up(P>0.05).A3 and B3 were only1 case each,which was descriptive analysis.Conclusion: When internal fixation with cannulated screw or locking plate is used to treat MasonⅡ/Ⅲ radial head fractures,both the anterior elbow approach and Kocher approach can obtain satisfactory clinical efficacy and safety.The anterior elbow approach is more advantageous in terms of operation time,blood loss and incision length,especially for radial head fractures with fracture line located in the anterior of radial head or combined with coronoid process fracture.For radial head replacement,the antecubital approach may still need to be improved,and Kocher approach or other approaches are recommended. |
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