Analysis of failure case of conservative treatment of Mason type I and II radial head fractures

doi:10.3877/cma.j.issn.2095-5790.2022.01.012

Abstract

Abstract:

Background

The treatment of isolated radial head fractures has been a subject of debate for many years. Conservative treatment has been used for nondisplaced and mild shift of the radial head fractures (Mason typeⅠandⅡ) . However, there are few reports on the risk factors and types of complications that influence the prognosis of conservative treatment. Therefore, for radial head fractures, fracture type may not be a single factor in determining the treatment, and other reasons for failure of conservative treatment are worth further exploring.

Objective

To investigate the major factors of failure of conservative treatment and the effect of operation on the failure cases.

Methods

Retrospective studies were performed on patients aged 16 to 65 years who were acute Mason typeⅠand II radial head fractures and treated conservatively in our trauma center from February 2010 to June 2015. Patients who were treated with additional ipsateral upper limb injuries, as well as craniocerebral trauma affected the prognosis of radial head fractures were excluded. Information were included on the patient's general condition, diagnosis, method and duration of immobilization. Follow-ups included complications, re-operation, pain (VAS score) , elbow motion, and Mayo elbow performance score (MEPS) .

Results

A total of 612 patients met the inclusive criteria, among which 345 patients were successfully followed up, including 205 males and 140 females, with a mean age of 37.5 years (17-65 years) and a mean follow-up time of 13.4 months (5.4-23 months) . Of the 345 patients, 27 (7.8%) turned to surgical treatment due to pain and mobility disorders. The mean immobilization duration of patients converted to surgical treatment was significantly higher than that of patients who were successfully treated in the conservative treatment group, including 19 Mason type II cases (70.4%) , 3 cases with osteochondral free bodies (11.1%) , 1 case with annular ligament capsule entrapment (3.7%) , and 4 cases with lateral ligament complex injury (14.8%) There were 25 patients (92.6%) with definite joint stiffness who underwent release surgery and 5 patients (18.5%) with ulnar nerve injury during rehabilitation who underwent nerve exploration and release. Among the 27 patients who switched to surgery, the mean VAS scores decreased from (5.6±1.4) points to (1.2±0.8) points, the mean MEPS increased from (55.6±8.6) points preoperatively to (89.6±4.9) points postoperatively, and the mean DASH scores decreased from (44.4±9.8) points to (15.4±5.9) points.

Conclusion

Fracture type, prolonged immobilization duration and associated injuries are the main reasons for the failure of conservative treatment in Mason typeⅠ and II radial head fractures. Surgical treatment can solve the corresponding complications such as joint stiffness, pain, ligament and free body cartilage incarceration.

Key words: Radial head fracture, Conservative treatment, Free cartilage body, Joint stiffness

Yanmao Wang, Chengdi Lu, Longxiang Shen, Jian Ding. Analysis of failure case of conservative treatment of Mason type I and II radial head fractures[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(01): 65-73.

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Figures/Tables 9

References 31

[1]	Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review [J]. Arch Orthop Trauma Surg, 2007, 127(2): 125-130.
[2]	Duckworth AD, Watson BS, Will EM, et al. Radial head and neck fractures: functional results and predictors of outcome [J]. J Trauma, 2011, 71(3): 643-648.
[3]	Harding P, Rasekaba T, Smirneos L, et al. Early mobilisation for elbow fractures in adults [J]. Cochrane Database Syst Rev, 2011, 6: CD008130.
[4]	Unsworth-White J, Koka R, Churchill M, et al. The non-operative management of radial head fractures: a randomized trial of three treatments [J]. Injury, 1994, 25(3): 165-167.
[5]	Weseley MS, Barenfeld PA, Eisenstein AL. Closed treatment of isolated radial head fractures [J]. J Trauma, 1983, 23(1): 36-39.
[6]	Bano KY, Kahlon RS. Radial head fractures--advanced techniques in surgical management and rehabilitation [J]. J Hand Ther, 2006, 19(2): 114-135.
[7]	Mahmoud SS, Moideen AN, Kotwal R, et al. Management of Mason type 1 radial head fractures: a regional survey and a review of literature [J]. Eur J Orthop Surg Traumatol, 2014, 24(7): 1133-1137.
[8]	Paschos NK, Mitsionis GI, Vasiliadis HS, et al. Comparison of early mobilization protocols in radial head fractures [J]. J Orthop Trauma, 2013, 27(3): 134-139.
[9]	Smits AJ, Giannakopoulos GF, Zuidema WP. Long-term results and treatment modalities of conservatively treated Broberg-Morrey type 1 radial head fractures [J]. Injury, 2014, 45(10): 1564-1568.
[10]	Burkhart KJ, Franke S, Wegmann K, et al.Mason I fracture—— a simple injury? [J]. Unfallchirurg, 2015, 118(1): 9-17.
[11]	Nietschke R, Burkhart KJ, Hollinger B, et al. Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients [J]. Obere Extrem, 2018, 13(2): 112-120.
[12]	郝有亮，周方，侯国进. 桡骨头骨折的治疗研究进展 [J/CD]. 中华肩肘外科电子杂志, 2016, 4(3): 186-190.
[13]	Duckworth AD, Wickramasinghe NR, Clement ND, et al. Long-term outcomes of isolated stable radial head fractures [J]. J Bone Joint Surg Am, 2014, 96(20): 1716-1723.
[14]	Lapner M, King GJ. Radial head fractures [J]. J Bone Joint Surg Am, 2013, 95(12): 1136-1143.
[15]	Liow RY, Cregan A, Nanda R, et al. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols [J]. Injury, 2002, 33(9): 801-806.
[16]	Herbertsson P, Josefsson PO, Hasserius R, et al. Displaced Mason type I fractures of the radial head and neck in adults: a fifteen- to thirty-three-year follow-up study [J]. J Shoulder Elbow Surg, 2005, 14(1): 73-77.
[17]	Furey MJ, Sheps DM, White NJ, et al. A retrospective cohort study of displaced segmental radial head fractures: is 2 mm of articular displacement an indication for surgery? [J]. J Shoulder Elbow Surg, 2013, 22(5): 636-641.
[18]	Hotchkiss RN. Displaced Fractures of the Radial Head: Internal Fixation or Excision? [J]. J Am Acad Orthop Surg, 1997, 5(1): 1-10.
[19]	Kaas L, Struijs PA, Ring D, et al. Treatment of Mason type II radial head fractures without associated fractures or elbow dislocation: a systematic review [J]. J Hand Surg Am, 2012, 37(7): 1416-1421.
[20]	Khalfayan EE, Culp RW, Alexander AH. Mason type II radial head fractures: operative versus nonoperative treatment [J]. J Orthop Trauma, 1992, 6(3): 283-289.
[21]	Bruinsma W, Kodde I, de Muinck Keizer RJ, et al. A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial [J]. BMC Musculoskelet Disord, 2014, 15: 147.
[22]	Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid [J]. Instr Course Lect, 1995, 44: 175-185.
[23]	Jordan RW, Jones AD. Radial Head Fractures [J]. Open Orthop J, 2017, 11: 1405-1416.
[24]	O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls [J]. Instr Course Lect, 2003, 52: 113-134.
[25]	Maripuri SN, Debnath UK, Rao P, et al. Simple elbow dislocation among adults: a comparative study of two different methods of treatment [J]. Injury, 2007, 38(11): 1254-1258.
[26]	Adolfsson LE, Nestorson JO, Scheer JH. Extensive soft tissue lesions in redislocated after simple elbow dislocations [J]. J Shoulder Elbow Surg, 2017, 26(7): 1294-1297.
[27]	Court-Brown CM, Cattermole H, McQueen MM. Impacted valgus fractures （B1.1） of the proximal humerus. The results of non-operative treatment [J]. J Bone Joint Surg Br, 2002, 84(4): 504-508.
[28]	Yoon A, King GJ, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? [J]. Clin Orthop Relat Res, 2014, 472(7): 2105-2112.
[29]	张堃，宋哲，王晨，等. 创伤性肘关节僵硬的诊疗现状和展望 [J/CD]. 中华肩肘外科电子杂志, 2018, 6(4): 9-11.
[30]	Rai S, Zhang Q, Tamang N, et al. Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes [J]. BMC Musculoskelet Disord, 2019, 20(1): 285.
[31]	唐晓俞，王志刚. 陈旧性肘关节恐怖三联征伴关节僵硬的手术治疗 [J/CD]. 中华肩肘外科电子杂志, 2020, 8(1): 43-50.

性别	例数	年龄（岁，±s）	BMI	受伤机制[例（%）]			Mason分型[例（%）]		AO/OTA分型[例（%）]
性别	例数	年龄（岁，±s）	BMI	跌倒	运动	其他	I型	II型	A2.2	B2.1	B2.2
男	205	34.2±10.1	21.1±2.2	77（37.6）	102（49.8）	26（12.7）	110（53.7）	95（43.9）	41（20.0）	148（72.1）	16（7.8）
女	140	42.4±10.6	22.5±2.8	107（76.4）	11（7.9）	22（15.7）	81（57.9）	59（42.1）	40（28.6）	87（62.1）	13（9.3）
t值/卡方值		-4.281	-0.523	6.789			0.926		3.121
P值		0.087	0.548	<0.01			0.537		0.109

性别	例数	年龄（岁，±s）	BMI	受伤机制[例（%）]			Mason分型[例（%）]		AO/OTA分型[例（%）]
性别	例数	年龄（岁，±s）	BMI	跌倒	运动	其他	I型	II型	A2.2	B2.1	B2.2
男	205	34.2±10.1	21.1±2.2	77（37.6）	102（49.8）	26（12.7）	110（53.7）	95（43.9）	41（20.0）	148（72.1）	16（7.8）
女	140	42.4±10.6	22.5±2.8	107（76.4）	11（7.9）	22（15.7）	81（57.9）	59（42.1）	40（28.6）	87（62.1）	13（9.3）
t值/卡方值		-4.281	-0.523	6.789			0.926		3.121
P值		0.087	0.548	<0.01			0.537		0.109

分型		例数	VAS（分，±s）	肘关节活动度（°，±s）				肘关节肌力（占健侧%）			转为手术率[例（%）]	MEPS评分（分，±s）
分型		例数	VAS（分，±s）	伸直	屈曲	旋前	旋后	屈曲	伸直	握力	转为手术率[例（%）]	MEPS评分（分，±s）
I型		191									8（4.2）
	头部	104	1.3±0.9	4.7±4.4	137.4±5.2	87.4±2.1	88.5±3.2	94.7±3.3	95.2±1.8	100		92.3±5.6
	颈部	87	1.2±1.5	4.9±2.7	129.5±5.8	88.0±2.3	89.1±3.2	93.6±2.2	95.1±1.8	100		91.9±6.2
II型		154	1.6±1.2	6.4±4.1	121.5±7.7	84.4±3.1	84.8±3.2	89.3±2.1	92.6±1.8	100	19（12.3）	86.5±7.4
	总和	345	1.4±1.2	5.5±3.8	128.3±6.8	86.2±2.4	87.0±3.2	92.4±2.3	94.0±1.8	100	27（7.8）	89.6±6.5

分型		例数	VAS（分，±s）	肘关节活动度（°，±s）				肘关节肌力（占健侧%）			转为手术率[例（%）]	MEPS评分（分，±s）
分型		例数	VAS（分，±s）	伸直	屈曲	旋前	旋后	屈曲	伸直	握力	转为手术率[例（%）]	MEPS评分（分，±s）
I型		191									8（4.2）
	头部	104	1.3±0.9	4.7±4.4	137.4±5.2	87.4±2.1	88.5±3.2	94.7±3.3	95.2±1.8	100		92.3±5.6
	颈部	87	1.2±1.5	4.9±2.7	129.5±5.8	88.0±2.3	89.1±3.2	93.6±2.2	95.1±1.8	100		91.9±6.2
II型		154	1.6±1.2	6.4±4.1	121.5±7.7	84.4±3.1	84.8±3.2	89.3±2.1	92.6±1.8	100	19（12.3）	86.5±7.4
	总和	345	1.4±1.2	5.5±3.8	128.3±6.8	86.2±2.4	87.0±3.2	92.4±2.3	94.0±1.8	100	27（7.8）	89.6±6.5

组别	例数	年龄（岁，±s）	男[例（%）]	受伤原因[例（%）]			制动时间（周，±s）	BMI
组别	例数	年龄（岁，±s）	男[例（%）]	跌倒	运动	其他	制动时间（周，±s）	BMI
保守成功组	318	38.0±11.2	191（60.1）	169（53.1）	104（32.7）	45（14.2）	2.1±1.4	22.3±2.4
转为手术组	27	32.1±10.9	14（51.9）	15（55.6）	9（33.3）	3（11.1）	3.4±1.2	21.2±2.1
t值/卡方值		5.163	0.786	1.021			-1.131	1.292
P值		0.672	0.462	0.610			<0.05	0.871
组别	例数	Mason分型[例（%）]		AO/OTA分型[例（%）]			VAS（分，±s）	MEPS评分（分，±s）
组别	例数	I型	II型	A2.2	B2.1	B2.2	VAS（分，±s）	MEPS评分（分，±s）
保守成功组	318	183（57.5）	135（42.4）	74（23.3）	227（71.4）	17（5.3）	1.4±1.3	89.6±6.4
转为手术组	27	8（29.6）	19（70.4）	7（25.9）	8（29.6）	12（44.4）	5.6±1.4	55.6±8.6
t值/卡方值		3.988		4.264			-4.781	8.009
P值		<0.05		<0.05			<0.05	<0.05

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