Study of characteristics and treatment of “kissing fracture” of humeroradial joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Yan ¹ , ZHOU Zihong ² , WEI Changbao ³ , TANG Wen ¹ ,  XU Kelin ^3,4

1. Department of Radiology, Wuxi Orthopaedic Hospital, Wuxi Jiangsu, 214062, P. R. China;
2. Department of Orthopaedics, Wuxi People’s Hospital, Wuxi Jiangsu, 214062, P. R. China;
3. Department of Orthopaedics, Wuxi Orthopaedic Hospital, Wuxi Jiangsu, 214062, P. R. China;
4. Department of Orthopaedics and Traumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi Jiangsu, 214000, P. R. China;

Corresponding author：

XU Kelin, Email: mingyin031@163.com

Keywords：

“Kissing fracture” of humeroradial joint; radial head fracture; humeral capitulum fracture; internal fixation

DOI：

10.7507/1002-1892.202206093

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Objective To explore the clinical characteristics and treatment of “kissing fracture” of humeroradial joint. Methods A clinical data of 12 patients with “kissing fracture” of the humeroradial joint between January 2016 and June 2021 was retrospectively analyzed. There were 8 males and 4 females with an average age of 41.9 years (range, 15-75 years). The fractures caused by falling in 7 cases, by falling from height in 3 cases, and by sports in 2 cases. The time from injury to admission was 2-72 hours (median, 2 hours). According to Mason’s classification, the radial head fractures were rated as type Ⅰ in 2 cases, type Ⅱ in 8 cases, and type Ⅲ in 2 cases. According to Grantham’s classification, the humeral capitulum fractures were rated as type Ⅰ in 10 cases and type Ⅱ in 2 cases. Among them, 4 cases of Grantham type Ⅰ humeral capitulum fracture were missed by X-ray film and confirmed by CT and/or MRI. Four cases were complicated with other injuries of elbow joint. The radial head fractures were fixed with screws or mini plate in 11 cases and treated conservatively in 1 case; the humeral capitulum fractures were fixed with screw or plate in 9 cases, removed in 1 case, and treated conservatively in 2 cases. X-ray film was used to evaluate the fracture healing; Mayo Elbow Performance Score (MEPS) was used to evaluate the functional recovery of the affected limb, and the range of motion (ROM) of the elbow joint of the affected limb was detected. Results All the incisions healed by first intention without early complications. All patients were followed up 10-24 months, with an average of 15.2 months. X-ray films showed that all fractures healed, and the healing time was 2-3 months, with an average of 2.3 months. At last follow-up, the ROM of flexion-extension of the elbow joint was 65°-161°, with an average of 136.9°; the ROM of rotation was 70°-180°, with an average of 149.2°. MEPS ranged from 70 to 100, with an average of 87.4; 8 cases were excellent, 2 cases were good, and 2 cases were fair; the excellent and good rate was 83.3%. Conclusion The “kissing fracture” of the humeroradial joint is relatively rare, and the humeral capitulum fracture is milder than radial head fracture. X-ray examination alone can easily miss the diagnosis of Grantham type Ⅰ humeral capitulum fracture. The “kissing fracture” of the humeroradial joint is treated according to the principle of intra-articular fracture, and the good effectiveness can obtain.

Citation： JIANG Yan, ZHOU Zihong, WEI Changbao, TANG Wen, XU Kelin. Study of characteristics and treatment of “kissing fracture” of humeroradial joint. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1369-1373. doi: 10.7507/1002-1892.202206093 Copy

1.	王健, 丁燕萍, 顾三军, 等. 桡骨头骨折合并肱骨小头软骨损伤的临床特点. 中华创伤骨科杂志, 2021, 23(11): 945-951.
2.	陈舒振, 黄玉良, 张理选. T形钢板联合Herbert螺钉内固定术治疗MasonⅢ型桡骨头骨折疗效及对围术期指标肘关节功能评分和并发症的影响. 河北医学, 2022, 28(3): 422-427.
3.	Harbrecht A, Hackl M, Leschinger T, et al. Radial head fractures with interposed capitellar cartilage fragment-hindrance to bone healing-a case series. Arch Orthop Trauma Surg, 2021, 141(9): 1615-1624.
4.	Rizzo M, Nunley JA. Fractures of the elbow's lateral column radial head and capitellum. Hand Clin, 2002, 18(1): 21-42.
5.	Claessen FM, Kachooei AR, Verheij KK, et al. Outcomes of concomitant fractures of the radial head and capitellum: The “Kissing Lesion”. J Hand Microsurg, 2016, 8(2): 100-105.
6.	Ward WG, Nunley JA. Concomitant fractures of the capitellum and radial head. J Orthop Trauma, 1988, 2(2): 110-116.
7.	Milch H. Unusual fractures of the capitulum humeri and the capitulum radii. J Bone Joint Surg (Am), 1931, 13: 882-886.
8.	张东耀. 桡骨小头合并肱骨小头骨折验案举隅. 世界最新医学信息文摘, 2016, 16(49): 269, 272.
9.	Birchler P, Erhardt J, Kaufmann J. Concomitant fractures of the capitulum humeri and the caput radii. Unfallchirurg, 2019, 122(1): 76-78.
10.	Böttcher J, Martineau P. Transverse capitellar shear fracture with interposed radial head fragment. A previously unclassified type of distal humeral fracture. Trauma Case Rep, 2019, 23: 100231. doi: 10.1016/j.tcr.2019.100231.
11.	Grantham SA, Norris TR, Bush DC. Isolated fracture of the humeral capitellum. Clin Orthop Relat Res, 1981, (161): 262-269.
12.	MacDonald JA. Fractures of the articular portion of the capitellum of the humerus in adults. Can Med Assoc J, 1959, 81(8): 634-636.
13.	Greenspan A, Norman A. The radial head, capitellum view: useful technique in elbow trauma. AJR Am J Roentgenol, 1982, 138(6): 1186-1188.
14.	Jakobson A. Fracture of the capitellum of the humerus in adults; treatment with intra-articular chrom-cobolt-molybdenum prosthesis. Acta Orthop Scand, 1957, 26(3): 184-190.
15.	Tomori Y, Nanno M, Sonoki K, et al. Surgical outcomes of coronal shear fracture of the distal humerus in elderly adults. J Nippon Med Sch, 2022, 89(1): 81-87.
16.	印飞, 孙振中, 宋升, 等. 肘前方入路治疗MasonⅡ型桡骨小头骨折合并Regan-MorreyⅡ型尺骨冠状突骨折. 中国修复重建外科杂志, 2015, 29(6): 783-784.
17.	余方正, 张怀保, 陈想想, 等. 无头变径空心螺钉结合微型钢板治疗中青年MasonⅢ型桡骨头骨折. 中华手外科杂志, 2022, 38(1): 23-26.
18.	高旭, 尹海磊, 卢建峰. 弹性钉闭合复位内固定微创治疗成人MasonⅡ型桡骨头骨折. 中国修复重建外科杂志, 2019, 33(8): 981-985.
19.	韩雷, 胡云根, 方伟利, 等. Ontable重建联合微型钢板固定与桡骨头置换治疗桡骨头MasonⅢ、Ⅳ型骨折. 中华手外科杂志, 2021, 37(6): 430-433.

1. 王健, 丁燕萍, 顾三军, 等. 桡骨头骨折合并肱骨小头软骨损伤的临床特点. 中华创伤骨科杂志, 2021, 23(11): 945-951.
2. 陈舒振, 黄玉良, 张理选. T形钢板联合Herbert螺钉内固定术治疗MasonⅢ型桡骨头骨折疗效及对围术期指标肘关节功能评分和并发症的影响. 河北医学, 2022, 28(3): 422-427.
3. Harbrecht A, Hackl M, Leschinger T, et al. Radial head fractures with interposed capitellar cartilage fragment-hindrance to bone healing-a case series. Arch Orthop Trauma Surg, 2021, 141(9): 1615-1624.
4. Rizzo M, Nunley JA. Fractures of the elbow's lateral column radial head and capitellum. Hand Clin, 2002, 18(1): 21-42.
5. Claessen FM, Kachooei AR, Verheij KK, et al. Outcomes of concomitant fractures of the radial head and capitellum: The “Kissing Lesion”. J Hand Microsurg, 2016, 8(2): 100-105.
6. Ward WG, Nunley JA. Concomitant fractures of the capitellum and radial head. J Orthop Trauma, 1988, 2(2): 110-116.
7. Milch H. Unusual fractures of the capitulum humeri and the capitulum radii. J Bone Joint Surg (Am), 1931, 13: 882-886.
8. 张东耀. 桡骨小头合并肱骨小头骨折验案举隅. 世界最新医学信息文摘, 2016, 16(49): 269, 272.
9. Birchler P, Erhardt J, Kaufmann J. Concomitant fractures of the capitulum humeri and the caput radii. Unfallchirurg, 2019, 122(1): 76-78.
10. Böttcher J, Martineau P. Transverse capitellar shear fracture with interposed radial head fragment. A previously unclassified type of distal humeral fracture. Trauma Case Rep, 2019, 23: 100231. doi: 10.1016/j.tcr.2019.100231.
11. Grantham SA, Norris TR, Bush DC. Isolated fracture of the humeral capitellum. Clin Orthop Relat Res, 1981, (161): 262-269.
12. MacDonald JA. Fractures of the articular portion of the capitellum of the humerus in adults. Can Med Assoc J, 1959, 81(8): 634-636.
13. Greenspan A, Norman A. The radial head, capitellum view: useful technique in elbow trauma. AJR Am J Roentgenol, 1982, 138(6): 1186-1188.
14. Jakobson A. Fracture of the capitellum of the humerus in adults; treatment with intra-articular chrom-cobolt-molybdenum prosthesis. Acta Orthop Scand, 1957, 26(3): 184-190.
15. Tomori Y, Nanno M, Sonoki K, et al. Surgical outcomes of coronal shear fracture of the distal humerus in elderly adults. J Nippon Med Sch, 2022, 89(1): 81-87.
16. 印飞, 孙振中, 宋升, 等. 肘前方入路治疗MasonⅡ型桡骨小头骨折合并Regan-MorreyⅡ型尺骨冠状突骨折. 中国修复重建外科杂志, 2015, 29(6): 783-784.
17. 余方正, 张怀保, 陈想想, 等. 无头变径空心螺钉结合微型钢板治疗中青年MasonⅢ型桡骨头骨折. 中华手外科杂志, 2022, 38(1): 23-26.
18. 高旭, 尹海磊, 卢建峰. 弹性钉闭合复位内固定微创治疗成人MasonⅡ型桡骨头骨折. 中国修复重建外科杂志, 2019, 33(8): 981-985.
19. 韩雷, 胡云根, 方伟利, 等. Ontable重建联合微型钢板固定与桡骨头置换治疗桡骨头MasonⅢ、Ⅳ型骨折. 中华手外科杂志, 2021, 37(6): 430-433.

Chinese Journal of Reparative and Reconstructive Surgery

Study of characteristics and treatment of “kissing fracture” of humeroradial joint

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