Comparison Between Radial Head Prosthesis Replacement And Open Reduction Internal Fixation In Treatment Of Mason Type-Ⅲ Or Ⅳ Radial Head Fracture

Objective: To compare anatomic radial head prosthesis replacement and openreduction internal fixation in treatment of Mason type-Ⅲ or Ⅳ radial head fracture.Methods: Between June2009and June2012,72patients with MasonⅢ or Ⅳradial head fracture were treated with anatomic radial head prosthesis replacement(rep-lacement group,n=32)and cannulated headless compression orthopedics screws orT-type locking plate and locking screws(internal fixation group, n=40). In replacementgroup, there were16males and16females with an age range of21to57years (mean,34.4years); these Mason type-Ⅲ or Ⅳ radial head fractures were both closed and acutefractures,21Mason type-Ⅲ radial head fractures and11Mason type-Ⅲ radial headfractures; the causes of injury were a fall in20cases, falling from height in6cases, andtraffic accident in6cases; the locations were left side in17cases and right side in15cases; and the time between injury and surgery was1-5days (mean,2.5days). Theradial head comminuted fractures were associated with11cases of dislocation of elbowjoint,7cases medial collateral ligament injury,4cases of ulna coronoid process fractureand10cases were not associated with injury. In internal fixation group there were19males and21females with an age range of22to63years (mean,38.1years); theseMason type-Ⅲ or Ⅳ radial head fractures were both closed and acute fractures,27Mason type-Ⅲ radial head fractures and13Mason type-Ⅲ radial head fractures; thecauses of injury were a fall in25cases, falling from height in8cases, and trafficaccident in7cases; the locations were left side in24cases and right side in16cases; and the time between injury and surgery was1-6days (mean,3.0days).The radial headcomminuted fractures were associated with13cases of dislocation of elbow joint,7casesmedial collateral ligament injury,6cases of ulna coronoid process fracture and14cases were not associated with injury. There was no significant difference in gender, age,sides，fracture classification，cause of injury, complication, time from injury to operationand other general information between2groups（P>0.05）. The elbow flexion androtation range of patients in postoperative follow-up is measured with a protractor andkeep a record of elbow pain, varus-valgus stability and daily activity. Evaluate thefracture healing, prosthesis dislocation and loosening by elbow anteroposterior andlateral film. All data analysis were performed by SPSS13.0statistics software and theelbow function were evaluated by Mayo elbow function total score between the twogroups.Results: All patients were followed up for11to42months, with an average of26months. Incisions obtained healing by first intention in2groups. In replacement group,elbow heterotopic ossification occurred in1case and elbow stiffness occurred in1casebecause prosthesis was too long after12months. There were not complicationsincluding profound branch of radial nerve injury, prothesis dislocation and loosening. Ininternal fixation group, elbow flexion angle lost35°in1case and delayed unionoccurred in3cases, nonunion in2cases, and internal fixation failure in2cases. Therewere not complications including implants loosening, rupture and radial head necrosis.According to Mayo elbow functional evaluation criteria, the scores were85.83±10.76inreplacement group and70.51±9.25in internal fixation group, showing significantdifference（P＜0.05）.The results were excellent in19cases, good in7cases, fair in4cases and poor in2cases with an excellent and good rate of81.2%in the replacementgroup. The results were excellent in15cases, good in8cases, fair in12cases and poorin5cases with an excellent and good rate of57.5%in internal fixation group.Conclusion: Anatomic radial head prosthesis replacement is better than openreduction internal fixation in treatment of Mason type-Ⅲ or Ⅳ radial head fracture inshort-term，but medium and long-term clinical curative effect remain to be observed.