Comparison Between Excision And Prosthesis Replacement Of Irreparable Radial Head Fractures

Research background:Radial head fractures was2.8-3.0per10,000inhabitants per year, due to its ch aracteristic of anatomical and injuries, comminuted radial head fractures has a large proportion in these injures. Because of this high incidence, the treatment in this regi on’s fracture is a hotspot in the field of elbow injury, Depending on the degree of fracture a we can take different treatments such as:plaster immobilization, excision, internal fixation, prosthesis replacement, unfortunately, there is still a majority of p atients did not recover to the desired function. Therefore, elbow as a commitment c omposition undertake the upper fine operation, strive to restore the function of the r adial head fractures before level, take a functional exercise early in postoperative, re duce the complications such as muscle contracture Is the ultimate goal of all treatm ent.The modified Mason’s classification is commonly used to classify radial head fr actures is the current widely used classification.Divided into type Ⅰ, this kind of sim pie radial head fractures by conservative treatment can be basically recovered better prognosis, the method is recognised by people are consistent. As the intra-articular f ractures such as:Mason type Ⅱ and part of Mason type Ⅲ, Open reduction and int ernal fixation with most doctors approved procedure, although there are still some c omplications such as osteonecrosis. Radial head resection as a classic operation in th e last century in treatment of radial head comminuted fractures and irreparable radia1head injury, it showes certain advantage In reducing elbow pain and improve the f unction of buckling and rotations, it has been extensively used in a longer period.B ut it should not be ignored is series of complications caused by mechanical instabili ty after the radial head resection, such as pain in the elbow and wrist joints, etc,an d the complications of surgery has a wide range of cognitive by the physician. With the development of material science and shoulder elbow surgery technology progres s, radial head replacement began in the treatment of irreparable radial head injury, Radial head prosthesis implantation can restore proximal radius’s anatomical structure s close to the normal, thus reached a new stable in mechanics, it has unique advant age in alleviating the pain when rotation and buckling and improve the range. Even so, radial head replacement prosthesis still exist problems such as loosening, infecti on and instability caused by prosthesis mismatch,etc.Therefore,when we in treatment of include nonreconstructable MasonⅢ radial he ad fracture, the old fracture of radial head,and the radial head malunion, select the r adial head resection or radial head replacement in many cases exist controversial.Objective:In order to solve the above problem, This research mainly through the collectio n the clinical information of nonreconstructable radial head injury patients in our ho spital which take the operation treatment of radial head excision or radial head repl acement, to provide relevant basis about how to select the optimal treatment progra m when surgeon encounter this kind of patients.Methods:1. Collection the clinical information of77radial head fractures patients (77elbow) from June2000to August2013,whom received Radial head resection and Radial head Prosthesis replacement, after screening out56cases were identified and followed up effectively, dropout rate was16.4%. Then all the patients were divided into two different groups,35patients in the resection group (grope I) and21patients in the replacement group (group II)2. The last one follow-up were assessed in regard of X-ray imaging, range of flexion and extension,rotary motion, the elbow of the hospital for special surgery scoring system (HSS) functional rating scores, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Elbow and wrist joints visual analogous scale(VAS) of pain.Results:1. Radial head resection group and replacement group postoperative follow-up general condition. 1.1The average follow-up time were72(ranged from12to156) months in group I,38(ranged from7to100) months in group II. Two groups of patients with postoperative incision were primary healing. No dislocation infection, loose cases group II.1.2There are2cases of heterotopic ossification in replacement group,2cases of heterotopic ossification in resection group. There was no statistically significant difference compared the two groups (P=0.152)。2. Radial head resection group and replacement of postoperative follow-up comparisoning about elbow and wrist joints various functional evaluation index.2.1. The elbow HSS functional rating score averaged85.4±7.5points in resection group and91.3±5.6points in replacement group, differences between the two groups have statistical significance (p<0.05), The score on the DASH form averaged16.5±5.1points in esection group and13.6±6.2points in replacement group,there was no significant difference between the two groups (p>0.05).2.2. Elbow range of motion averaged3°(extension loss) to132°(flexion) in resection group and5°to131°in replacement group,there was no significant difference between the two groups (p>0.05). Pronation-Supination of the forearm averaged74°-71°in resection group,81°-82°in replacement group (p<0.05). the difference has statistical significance.2.3. Compared with the contralateral forearm, the average increase in the carrying angle was6.30±2.36°in resection group and1.72±1.03°in replacement group, Differences are statistically significant (p<0.05).2.4. Elbow pain scores for differences between the two groups has no statistical significance (P>0.05), In hand wrist pain score, replacement group was lower than that of the resection group (p<0.05).Conclusions:In postoperative of patients with irreparable radial head injury, the change of carrying angle and olecranarthritis of the radial head replacement group was significantly lower than the resection group, replacement group has better outcome than resection group in pronation and supination, so radial head replacement has a satisfactory effect in the clinical curative effect evaluation at medium-term follow-up.Therefore, the radial head comminuted fracture or old injury irreparable should be a priority of the radial head replacement in order to ensure the elbow stability and function of the elbow complete,then in reducing elbow, wrist joint pain also to have certain benefits.