Radial Head Dislocation Associated with an Ipsilateral Open Type II Gustilo-Anderson Fracture of the Radial Shaft

Radial head dislocation associated with an ipsilateral radial shaft fracture is a rare lesion, even more so for open lesions. Few cases have been found in the literature. We report this case due to its exceptional nature and discuss the mechanism of onset. A twenty-five-year-old patient presented with a dislocation of the radial head associated with a GUSTILO ANDERSON type II open fracture of the radial shaft following an occupational accident. He was managed twenty-four hours after the trauma. The mechanism was a direct blow. The dislocation was reduced by external manoeuvre following open reduction of the radial shaft. The fracture was stabilized by two Kirschner wires following reduction. The result at 12 months was satisfactory from a clinical and radiological standpoint.

Current concepts in the management of radial head fractures

Fracture of the radial head is a common injury. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. As treatment strategies have changed over the years, with an increasing amount of literature on this subject, the purpose of this article was to provide an overview of current concepts of the management of radial head fractures.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

The Early Outcomes with Titanium Radial Head Implants in the Treatment of Radial Head Comminuted Fractures

The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium implants of radius in the treatment of radial head fractures （Mason Type Ⅲ： 6; Mason Type Ⅳ： 4） in l0 consecutive patients （mean age, 38 years） were evaluated over a mean time of 23.7 months （18-31 months）. The patients were assessed on the basis of physical examination, functional rating （Mayo） and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and l patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head im- plants may be indicated for the Mason Type Ⅲ and Mason Type IV radial head fractures.

Fracture of proximal radius combined with dislocation of the radial head:a case report

Forearm fractures are prevalent which include radius fractures,ulna fractures,or both radius and ulna fractures.Proximal radius fractures combined with dislocations of the radial heads are rare and easily misdiagnosed.The authors present and discuss a case of proximal radius fractures associated with radial head dislocations.A 36 years old male was admitted to the hospital due to pain and activity limitation in his left elbow for 7 hours due to a car accident.An X-ray of the left elbow joint revealed a“left radius fracture with surrounding soft tissue edema”.During the procedure,the radial head was found to be dislocated forward.A 3.0 mm anchor was used to fix the annular ligament.Radius fractures combined dislocations of the radial heads are rare and may be missing the diagnosis.Before undergoing surgery,the possibility of elbow dislocation should be evaluated.Wire anchors can provide reliable fixation.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Incidence and analysis of radial head and neck fractures

AIM: To investigate several complications like persistent radial head dislocation, forearm deformity, elbow stiffness and nerve palsies, associated with radial head fractures. METHODS: This study reviewed the clinical records and trauma database of this level Ⅰ Trauma Center and identified all patients with fractures of the radial head and neck who where admitted between 2000 and 2010. An analysis of clinical records revealed 1047 patients suffering from fractures of the radial head or neck classified according to Mason. For clinical examination, range of motion, local pain and overall outcome were assessed. RESULTS: The incidence of one-sided fractures was 99.2% and for simultaneous bilateral fractures 0.8%. Non-operative treatment was performed in 90.4%(n = 947) of the cases, surgery in 9.6%(n = 100). Bony union was achieved in 99.8%(n = 1045) patients. Full satisfaction was achieved in 59%(n = 615) of the patients. A gender related significant difference(P = 0.035) in Mason type distribution-type Ⅲ fractures were more prominent in male patients vs type Ⅳ fractures in female patients-was observed in our study population. CONCLUSION: Mason typeⅠfractures can be treated safe conservatively with good results. In type Ⅱ to Ⅳ surgical intervention is usually considered to be indicated.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Ipsilateral dislocation of the radial head associated with fracture of distal end of the radius： a case report and review of the literature

Dislocation of the radial head in adults is uncommon. A simultaneous dislocation of the radial head and fracture of the ipsilateral distal end of radius with no other associated injuries is extremely rare. As far as we know, such an injury after an unusual mode of injury has been seldom reported in the English literature. We report such a case without any associated injuries or comorbidity. Closed reduction was performed within two hours after injury and results were satisfactory. Immobilisation was continued for3 weeks. Gradual mobilisation was started after removal of the plaster under the supervision of a physiotherapist. At 6 months＇ follow-up, the patient had no residual pain at the elbow with full flexion ＆ extension. Almost full supination with a restriction of last 10 degrees of pronation was achieved. There was no evidence of instability of the elbow.

Review of management of unstable elbow fractures

Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstablefractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury.

闭合复位钛制弹性髓内钉内固定治疗MasonⅡ型桡骨头骨折疗效分析

目的探讨闭合复位钛制弹性髓内钉内固定治疗MasonⅡ型桡骨头骨折的临床效果。方法选取2019年6月至2021年6月郑州市第七人民医院收治的80例MasonⅡ型桡骨头骨折患者作为研究对象,按照随机数表法将其随机分为观察组(40例)和对照组(40例),观察组患者采用闭合复位钛制弹性髓内钉内固定治疗,对照组患者采用手法复位联合石膏外固定治疗,对比观察两组患者临床疗效、肘关节活动度及并发症发生情况。结果术后6个月,观察组患者肘关节功能恢复为优者30例、良者8例、可者2例,明显优于对照组患者的肘关节功能恢复为优者14例、良者17例、可者7例、差者2例(Z=-3664,P<0001);术后6个月,观察组患者肘关节屈曲、伸展及前臂旋前、旋后活动度均明显大于对照组(t=3643、2868、3366、3588,P=0001、0005、0001、0001);术后随访1年,观察组患者均未出现并发症,其并发症发生率明显低于对照组患者的并发症发生率100%(χ^(2)=4211,P=0040)。结论与手法复位联合石膏外固定相比,闭合复位钛制弹性髓内钉内固定能够明显提高MasonⅡ型桡骨头骨折患者的肘关节功能恢复效果,改善肘关节活动度,减少术后并发症的发生,值得临床推广应用。

阔筋膜在成人孟氏骨折中治疗桡骨头脱位的应用

目的分析阔筋膜在成人孟氏骨折中治疗桡骨头脱位的应用效果。方法回顾性分析2015年8月至2022年7月32例孟氏骨折成年患者的临床资料,按手术方式不同分为观察组(阔筋膜治疗)和对照组(单纯韧带缝合)各16例。术后根据X线评估桡骨头复位情况及BrobergMorrey肘关节功能评分系统评估肘关节功能近、远期疗效。结果两组在术后X线检查桡骨头复位情况效果均满意。观察组1例女性患者因尺骨折延迟愈合,半年后行二次植骨术,其余患者均愈合良好,愈合时间(3.3±0.5)个月。术后3个月时Broberg-Morrey肘关节评分观察组(91.19±10.29)分,对照组(84.69±11.53)分。术后2年时Broberg-Morrey肘关节评分观察组(95.06±4.53)分,对照组(90.63±7.46)分,差异均有统计学意义(P<0.05)。结论阔筋膜在成人孟氏骨折中治疗桡骨头脱位较单纯缝合效果好。

A rare combination of fractures around the elbow： Bony variant of terrible triad

Radial head and coronoid fractures without posterior dislocation of the elbow have not been recorded in the literature. There is no literature documenting the combined fractures of the radial head, capitellum and coronoid process together in the same elbow. This is a case report highlighting this combination of fractures in a 30 year old patient treated with open reduction and internal fixation of all three fractures. The patient was followed up for 28 months and had a good range of motion of the elbow without any instabiliW. Thus such a triad with no ligamentous injuries could depict a bony variant of terrible triad and a mechanism for such an injury has also been explained.

钢板内固定与外架固定治疗儿童BadoⅠ型陈旧性孟氏骨折疗效对比

目的:比较儿童BadoⅠ型陈旧性孟氏骨折尺骨截骨后钢板内固定和外架固定的疗效。方法:收集2015年6月至2022年12月郑州大学第一附属医院收治的儿童BadoⅠ型陈旧性孟氏骨折患儿的资料,患儿均行环状韧带探查联合尺骨截骨术,其中24例尺骨截骨后采用钢板内固定,14例采用外架固定。术前及术后12个月,测量肘关节和前臂活动度,行肘关节Mayo功能评分,记录术后并发症发生情况。结果:两组患儿术后肘关节屈伸、前臂旋转活动度和肘关节Mayo功能评分均高于术前(P<0.05),但是术前术后差值两组比较差异无统计学意义(P>0.05)。钢板内固定组手术时间及出血量均大于外架固定组(P<0.05)。两组患儿肱桡关节再脱位、切口感染和尺骨愈合不良发生率差异无统计学意义(P>0.05)。结论:对于儿童BadoⅠ型陈旧性孟氏骨折,尺骨截骨后钢板内固定和外架固定均有效。

Comminuted fractures of ipsilateral radial head and distal radius： A rare injury pattern

A new injury pattern of comminuted fractures of ipsilateral radial head and distal radius of forearm in an adult was described. To the best of our knowledge, this type of injury pattern had not been previously reported in the English literature. The possible mechanisms of injury were that the rebound forces were volar to the distal radius as the fracture was dorsally angulated, with a continuation of the radial head fracture due to the longitudinal impaction of the radius against the capitellum. Open reduction and internal fixation can obtain excellent results within 7 12 days after injury. We hope that our experience will increase the awareness of the occurrence of a double injury of the forearm.

SPIN螺钉治疗成人Mason-Ⅱ型和Ⅲ型桡骨小头骨折

目的比较和评估成人Mason-Ⅱ型和Ⅲ型桡骨小头骨折采用桡骨小头切除和切开复位SPIN螺钉内固定的治疗效果。方法共有59例Mason-Ⅱ型和Ⅲ型桡骨小头骨折纳入研究。35例采用桡骨小头切除术(甲组),24例采用切开复位SPIN螺钉内固定方法(乙组)。平均年龄43岁和38岁,平均随访5.1年和1.3年。根据Broberg和Morrey评分标准,通过对患者的疼痛程度、活动范围、肌力和影像学资料评估肘关节功能。结果甲组平均伸肘丢失14.7°,屈肘132.1°,乙组分别为7.2°和134.4°。提携角甲组平均为8.5°,乙组平均为1.7°。和乙组相比,甲组伸肘、前臂旋前和旋后肌力明显下降(<0.01)。Broberg和Morrey评分甲组平均为80.6分,乙组平均为91.3分。(=0.0035)结论:Mason-Ⅱ型和Mason-Ⅲ型桡骨小头骨折采用SPIN螺钉进行内固定治疗比采用桡骨小头切除术治疗能获得更大的活动范围,更好的肌力和更好的功能。结论支持我们建议Mason-Ⅱ型和Mason-Ⅲ型桡骨小头骨折采用SPIN螺钉进行内固定治疗。

三枚交叉桥架埋头钉与锁定接骨板固定MasonⅢ型桡骨头骨折稳定性的有限元分析

目的:利用有限元方法比较3枚交叉桥架埋头钉和锁定接骨板(锁定钢板)固定MasonⅢ型挠骨头骨折的生物力学稳定性。方法:利用逆向建模技术,将1例25岁健康男性青年挠骨CT数据及内固定数据导入相关软件,分别建立MasonⅢ型挠骨头骨折的3枚交叉桥架构型埋头钉与锁定钢板的三维有限元模型,对挠骨头进行100 N轴向加载,比较两组模型最大位移、内固定上最大Von Mises应力及应力分布等指标。结果:3枚交叉桥架埋头钉组和锁定钢板组最大位移分别为0.069 mm和0.087 mm,内固定上Von Mises应力峰值分别为18.59 MPa和31.85 MPa,3枚交叉桥架埋头钉组应力分布更加均匀。结论:两种内固定方式均能提供良好的固定强度,3枚交叉桥架埋头钉较锁定钢板固定方式更具稳定性,应力分布更均匀。

小钢板固定治疗Mason 2型桡骨头骨折

目的 探讨小钢板固定治疗Mason 2型桡骨头骨折的疗效。方法 采用小钢板固定治疗8例Mason 2型桡骨头骨折患者。记录骨折愈合时间、关节活动度情况。采用肘关节Mayo评分评价疗效。结果 患者均获得随访,时间6~12(8.3±1.8)个月。骨折均愈合,时间3~6(4.3±0.9)个月。末次随访时,肘关节屈曲120°~140°(128.5°±7.8°)、伸直0°~5°(3.3°±0.8°),前臂旋前85°~95°(90.7°±6.8°)、旋后75°~95°(85.5°±8.4°);肘关节Mayo评分85~95(92.3±2.7)分,其中优7例,良1例。结论 小钢板固定治疗Mason 2型桡骨头骨折疗效满意。

肱骨小头软骨损伤碎片扦插桡骨头骨折缝隙的诊治误区分析

目的探讨肱骨小头软骨损伤(CCI)碎片扦插桡骨头骨折(RHF)缝隙临床特点和诊治误区。方法回顾性分析2011年1月至2022年12月RHF术中探查证实伴CCI,且CCI碎片扦插RHF缝隙9例患者临床资料。男6例,女3例;年龄17~69岁,平均为36.1岁。分析其临床特点。RHF按Mason分型,CCI按王健方法分型。随访13~30个月,平均随访14.2个月。患肢功能按Mayo肘关节功能评分标准(MEPS)评价。结果该骨折占RHF的6.8%,占RHF伴CCI的25%。跌伤6例,坠落伤3例。均有明显肘关节屈伸和前臂旋转活动受限,4例局部有骨擦音。6例因RHF较重、3例RHF较轻但局麻后体检试验阳性行手术。Mason Ⅰ、Ⅱ和Ⅲ型各1、7和1例。CCI分型Ⅰ、Ⅱ、Ⅲ型各3、4和2例。CCI仅1例Ⅲ型术前获MRI诊断,其余8例影像学检查均阴性。CCI位于肱骨小头外侧、后外侧和前外侧各4、3和2例;范围12~100 mm^(2),平均19.8 mm^(2)。RHF均内固定;CCI摘除8例,缝合固定1例,Ⅱ型行微骨折处理2例。RHF均愈合。末次随访,MEPS评价优良率88.9%。结论CCI碎片扦插RHF缝隙临床少见,易漏诊,但患者活动明显受限、局部骨擦音和局麻后体检试验阳性常提示该骨折可能;手术探查仍是诊断金标准,值得重视;CCI应按类型选择不同处理方法。