Selection And Analysis Of Clinical Results Of Surgical Methods In Treatment Of Radial Head Fractures

Radial head fracture is a common clinical elbow fracture, damage mostly because of indirect violence. In a series of studies showed that radial head fractures account for about about 33% of elbow fractures; about 3%-4% in the body fractures. Radial head fractures can be single injury, and also may be part of a wide range of elbow injury. The common associated injuries include ulnar collateral ligament; ulna coronoid fractures; olecranon fracture; elbow dislocation. Before Surgery, the patient must be carefully evaluated, so as to exclude the associated ligament injury and pathologic fracture. Principles of treatment in order to ensure anatomically restore stability elbow maximum should restore elbow flexion and forearm rotation. If not treated properly, often nonunion, infection, radial nerve injury,traumatic arthritis, heterotopic ossification, elbow stiffness and other complications. Clinically,patients with fractures of the radial head mostly according to Mason typing to treatment options. Mason I choosing conservative treatment basically has formed a unified opinion;MasonⅡhas two selection conservative treatment or surgical treatment.With the development of anatomy and physiology, there is growing recognition of the important role of the radial head in maintaining stability and played in conductivity elbow forces. But also for intra articular fracture, manual reset is often more difficult; And it is difficult to maintain reduction through external fixation; Delay early functional exercise. So it is the best choice of open reduction and internal fixation in current clinical. Mason III, IV fractures were seriously injured, Most require surgery. The most commonly used surgical clinic for open reduction and internal fixation, radial head excision and the radial head arthroplasty.Objectives:To evaluate and analyze the clinical efficacy of the various surgical treatment methods of the radial head fractures.Method: In this study, we retrospective analyze 67 cases clinical data of radial head fracture from December 2005 to December 2014 in our hospital. 46 patients choose ORIF. 9cases of patients with radial head excision. 12 cases of patients with radial head arthroplasty.Patients were followed up for 6-24 months; Record elbow activity arc, elbow forearm and hand strength, spinning forearm, elbow whether stability, feeling their pain and other conditions. According to Broberg and Morrey score standard score for each patient; For each surgical application of statistical comparative analysis of the contralateral limb surgery and elbow and forearm rotation degrees, analysis of the clinical effects of various treatments.Results: ORIF: All 46 cases have been followed up. All patients were followed up about8-15 weeks, an average of 9.8 weeks. Following Brobegr and Morrey score standard scores:the average score 92 points, excellent 30 cases, good 12 cases, fair 3cases, and poor 1 case,good rate of 91.3%. The average elbow flexion radian(132±2)°; Average forearm Pronation were(85±2)°; Average forearm Supination were(81±2)°. There were 4 patients with mild pain after elbow, 3 patients of mild weakening grip, 3 patients with different degrees of heterotopic ossification, 5 patients with active arc of elbow poor, 1 patients with elbow stiffness. Postoperative elbow and forearm motion and contralateral comparison, P>0.05, In Statistics the difference was not significant.Radial head resection: All 9 cases have been followed up. Following Brobegr and Morrey score standard scores: the average score 70 points, excellent 3cases, good 3cases, fair2 cases, and poor 1 case, good rate of 66.7%. The average elbow flexion radian(115±3)°;Average forearm Pronation were(68±3)°; Average forearm Supination were(69±2)°.There were 3 patients with mild pain after elbow, 2 patients with active arc of elbow poor.Postoperative elbow and forearm motion and contralateral comparison, P<0.05, In Statistics the difference was significant.Radial head arthroplasty: All 12 cases have been followed up. Following Brobegr and Morrey score standard scores: the average score 85 points, excellent 7 cases, good 3 cases,fair 1 cases, and poor 1 case, good rate of 83.3%. The average elbow flexion radian(125±2)°; Average forearm Pronation were(83±2)°; Average forearm Supination were(80±2) °. There were 2 patients with Slight elbow pain, 1 patients with Muscle weakness, 1patients with elbow limited mobility. Postoperative elbow and forearm motion and contralateral comparison, P>0.05, In Statistics the difference was not significant.Conclusions: There are three methods of Surgical treatment of the radial head fractures:ORIF, radial head resection and radial head arthroplasty. when to choice the methods the type of fracture, complications injury, soft tissue injury, the patient’s age and the demand for quality living conditions should be considered. For Mason Ⅱ radial head fracture with fragment involving>30% of the articular surface or displacement>2mm, Mason III, IV radial head fracture which could be reconstructed, should choose ORIF with early postoperative functional exercise reasonable guidance can get good clinical results. Mason III, IV radial head fracture which could be not reconstructed should be preferred radial head arthroplasty.