The Clinical Follow-up Research Of Radial Head Fracture And Related Injury

Part 1 Effectiveness of open reduction internal fixation in treating fractures of radial headObjective: To explore the effectiveness of different fixation in open reduction internal fixation for the MasonⅡ and Ⅲ fracture of radial head.Methods: Retrospectively analyzed the follow-up cases in 54 cases who underwent open reduction internal fixation dated from February 2012 to February 2015. By comparing Herbert screw, absorbable screw and mini plate to explore the effectiveness of different internal fixations.Results: The follow-up time ranged from 10 months to 27 months, the average time was 14 months. The incision healed by first intention. All the fractures was clinical healing. The average healing time was 11.06±2.24 weeks. All the fractures were cured. The function of the elbows( according to Broberg and Morrey scale) showed excellent in 15 cases, good in 30, fair in 2 and poor in 2, the good-excellent rate was 91.8%. There was no infectious patient. There were 5 cases of heterotopic ossification, one in group of Herbert screw, 2 in the group of absorbable screw and 2 in the group of mini plate. No case of osteolysis, nerve injury, radial head necrosis or nonunion. There were no statistical difference in the good-excellent rate, Broberg and Morrey scale, the degree of the elbow’s pronation and supination, the healing time and the incidence of the complication.Conclusion: It is suitable to choose the Herbert screw, absorbable screw or the miniplate as the fixation for the radial head fracture. The choice for the fixation depends on the type of radial head fracture. We can select the Herbert screw and the absorbable screw for the simple fracture or the amount of the broken bone block less than 3. Their effectiveness is similar. It is a good choice for the complex fracture, radial neck fracture and radial head fracture with the bone loss to choose the mini plate. But in difficult situation, we should choose the radial head excision or replacement.Part 2 Effectiveness of radial head replacement for the comminuted radial head fractureObjective: To discover the clinical effectiveness of the therapy of radial head replacement for the comminuted radial head fracture.Methods: Retrospectively analyzed 12 cases suffered comminuted radial head fracture who underwent the therapy of radial head replacement dated from March 2010 from March 2015. To know the efficacy of radial head replacement for the comminuted radial head fracture.Results: All the cases had been followed up. The follow-up time was 22.3±9.3 months(10-44 months). No ulnar nerve, radial nerve and incision infection was seen in the follow-up. No prosthetic loosen happened. There were a case of mild valgue instability in the elbow, 2 cases of mild heterotopic ossification, a case of osteoarthritis, a case of mild pain. The mean flexion of the elbow was 113.5°(95-130°), the mean pronation/supinantion was 53.2°(45°-65°)/53.4°(45°-65°). The result was 1 case in excellent, 9 cases in good, 2 cases in fair.Conclusion: The long-term effect of radial head replacement is still not clear. We should be prudent to choose the method of radial head replacement. This method has a exact effect, and the clinical effect is satisfactory. The function of the postoperative elbow was good. So it is a good method for the comminuted radial head fracture.Part 3 The clinical follow-up review of the terrible triad of the elbowObjective: to explore the diagnose and treatment of the terrible triad of the elbow.Methods: 14 out of 15 cases of the terrible triad of the elbow from May 2010 to May 2015 were followed up. The average follow-up time was 19 months(11-33 months). Both the medial and lateral incision were applied in every cases. Dislocated joints were reset, the type Ⅰ fractures of coronoid process were fixed with steel wire or non-absorbable wire. Type Ⅱ or Ⅲ fractures of coronoid process were fixed with Herbert screw. The fractures of radial head were fixed with Herbert screw, absorbable screw and mini plate or replaced by radial head prosthesis. The lateral ligaments were fixed by non-absorbable suture or rivet with suture. We tested the elbow’s stability before closing the incision. Three cases were unstable, one case was repaired the medial collateral ligament, the others were fixed with external fixator.Results: The average follow-up time was 19 months(11-33 months). The clinical curing time was 11-17 weeks, average time is 14.2 weeks. One case was in joint stiffness. Others’ flexion range was from 95 degrees to 135 degrees, and the average range was 110.5 degree. Rotation range was from 75 degrees to 125 degrees, and the average range was 114 degrees. 3 cases of patients with heterotopic ossification in imaging, and the function of the elbow was not influenced. According to the Mayo scale: the results were excellent in 2 cases, good in 8 cases, fair in 2 cases and bad in 2 cases.The excellent-good results was in 71.4%.Conclusion: The terrible triad of the elbow is high-energy injury, and the surgery effect is still not good. There are controversies in the repairing of fractures and ligaments. The choice for lasso or screw is depended on the type of the coronoid process fracture. We tried our best to choose the internal fixation for the fracture of radial head. We should pay attention to the selection of radial head replacement. The radial head excision should be under a ban. If the elbow is still unstable after Conventional repair, we should choose the external fixator.Part 4 The clinical follow-up review on posterior Monteggia fractureObjective: To explore the diagnosis and establish an effective treatment for the Monteggia fracture-dislocation of proximal ulna in adult.Methods: Between April 2010 and April 2015, 18 patients suffered from posterior Monteggia fracture-dislocation were treated surgically, 15 patients were followed up at a mean of 17 months. All operations were through the posterior midline approach. The fracture of radial head and coronoid process were reduced and fixed at first, the proximal ulna fractures were fixed with just a plate in 11 cases, plate associated with K-wires in 3, and K-wires tension band in 1.Results: All fractures healed. The average cure time was 5.3 months. The mean Mayo Elbow Performance Score( MEPS) was 89.7 points(70-100 points), excellent and good results were achieved in 93.3%.Conclusion: Attension should be paid to the correct diagnosis, and it is keystone to anatomical reduction and stable fixation, which is basis for good function. We can choose the radial head excision for the over-65 patients whose elbow joint were stable.