Objective To review the research progress in the repair and reconstruction of isolated traumatic radial head dislocation with annular l igament injury in children. Methods In recent years, the related l iterature concering isolated traumatic radial head dislocation with annular l igament injury in children was reviewed. Results For isolated traumatic radial head dislocation with annular l igament injury in children, the surgery should be chosen as the main treatment, includingopen reduction and annular l igament reconstruction surgery. Triceps aponeurosis is usually used as reconstruction materials of annular l igament, mainly because the position of taking material of annular l igament is at the operative incision with less surgery trauma and short operative time; aponeurosis is tough and thick with rigid fixation and low risk of re-dislocation. Artificial materials are paid attention to increasingly because they are easy to get, have rigid fixation, and can avoid operative injury caused by taking material of annular l igament. Conclusion Currently active annular l igament reconstruction surgery should be taken; triceps aponeurosis is widely adopted as reconstruction materials of annular l igament and artificial materials have come to be a new research trend.
Objective To analyse the procedure and effectiveness of internal fixation in treatment of displaced radial head fractures. Methods Between August 2005 and May 2009, 35 patients with displaced radial head fractures underwent open reduction and internal fixation with SmartNail® and/or AO mini-plates. There were 28 males and 7 females with an average age of 28.4 years (range, 17-48 years). The injury mechanism included traffic accident in 16 patients, falling in 13, and falling from height in 6. According to Mason classification, 21 fractures were rated as type II, 9 as type III, and 5 as type IV. All fracturs were closed fractures. Six cases complicated by radial neck fractures, 1 case by olecranon fracture, 3 by posterior dislocations of the elbow, 1 by posterior dislocation of the elbow and coronoid process fracture, and 3 by medial collateral ligament injuries. The time from injury to operation was 3 to 7 days. Results Except 1 patient whose incision healed by second intention, healing of incision by first intention was achieved in the other patients. All patients were followed up 12-25 months with an average of 17 months. The average fracture healing time was 10.2 weeks (range, 8-16 weeks). At last follow-up, the average flexion and extension of the elbow was 119° (range, 95-145°). The average arc of forearm rotation was 126° (range, 90-175°). According to elbow functional evaluation criteria by Broberg and Morrey, the results were excellent in 18 cases, good in 13, and fair in 4; the excellent and good rate was 88.6%. Conclusion In treatment of displaced radial head fractures, open reduction and internal fixation can be performed with SmartNail® and/or AO mini-plates based on different fracture types and the short-term effectiveness is satisfactory.
To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment (internal fixation group, n=35) and with artificial radial head replacement (replacement group, n=30). In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years (mean, 30.7 years); the causes of injury were traffic accidentin 12 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days (mean, 3 days). In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years (mean, 32.5 years); the causes of injury were traffic accident in 7 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days (mean, 1.5 days). There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups (P gt; 0.05), so that 2 series of patients had comparabil ity. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups (P lt; 0.05), but no significant difference in elbow pronation or supination weakness (P gt; 0.05). In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement group, elbow flexion angle lost beyond 30º in 1 case after 1 year, elbow stiffness occurred in 1 case because prosthesis was too long. According to Broberg and Morrey elbow scores system, the scores were 69.51 ± 10.23 in internal fixation group and 81.55 ± 12.06 in replacement group, showing significant difference (P lt; 0.05). The results were excellent in 15 cases, good in 5 cases, fair in 11 cases, and poor in 4 cases with an excellent and good rate of 57.1% in internal fixation group; the results were excellent in17 cases, good in 5 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 73.3%. Conclusion Artificial radial head replacement can achieve better joint function compared with open reduction combined with internal fixation in treating Mason type-III comminuted fractures of radial head.
ObjectiveTo explore the effect of early rehabilitation nursing on elbow joint function recovery after artificial radial head replacement. MethodsFrom June 2010 to June 2012, 42 patients with artificial radial head replacement were randomly divided into two groups:trial group and control group. The control group was treated by the doctor instructions following routine rehabilitation therapy and nursing. The trial group received the guidance of professional rehabilitation nursing and early rehabilitation training. ResultsThe patients' range of elbow joint activities, alleviation of the pain, the strength grade, and the rehabilitation effect in the trial group was obviously better than those in the control group (P<0.05). There was no statistically significant difference between two groups in joint stability (P<0.05). ConclusionThe rehabilitation nursing should start early after the surgery for the artificial radial head replacement. It can prevent joint stiffness, joint conglutination and muscle disuse atrophy, reduce complications, and improve the quality of survival.
ObjectiveTo evaluate the short-term effectiveness of transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) for old radial head dislocation after open reduction of the radial head in children. MethodsA retrospective analysis was made on the clinical data of 25 children with old radial head dislocation between January 2008 and December 2010.There were 18 boys and 7 girls,aged 2 years and 5 months to 9 years and 5 months (mean,5 years and 11 months).The left side was involved in 13 cases,and the right side in 12 cases.The interval of injury and operation was 3 weeks to 30 months (median,14 months).The main presentations were abnormal mass in the anterior elbow,motion limitation of forearm pronation,and dorsiflexion inability of wrist and thumb.Three patients had radial nerve lesion.In 23 patients with simple radial head dislocation,transarticular fixation of humeroradial joint by Kirschner wire was used after open reduction of the radial head; in 2 patients with Monteggia fracture,transarticular fixation by Kirschner wire and additional proximal ulnar osteostomy were used. ResultsA primary healing of incision was obtained,without complication of infection,joint stiffness,or radial head necrosis.Twenty-four patients were followed up 29-58 months (mean,44.3 months); one case had re-dislocation,failed to be followed up at 2.5 months postoperatively.In 3 patients with radial nerve injury,neural function recovery was obtained in 2 cases,and no improvement was observed in 1 case.Twenty-three had no pain,no deformity,and no motion limitation of elbow and forearm except 1 patient with no improvement of neural function.The mean range of montion (ROM) of elbow flexion was 134° (range,125-140°),and the mean ROM of extension was -4° (range,-8-0°); the mean ROM of forearm pronation was 74° (range,65-80°),and the ROM of supination was 90°.According to Mackay's criteria,the results were excellent in 22 cases,good in 1 case,and poor in 1 case at 2 years after operation. ConclusionThe transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) is a feasible and effective method to treat old radial head dislocation in children based on a short-term follow-up.
ObjectiveTo compare the effectiveness of transosseous tunnel fixation and drilling fixation for repair of lateral collateral ligament complex (LCLC) in treatment of terrible triad of elbow (TTE).MethodsA clinical data of 50 patients with TTE between June 2012 and January 2018 were retrospectively analyzed. The LCLC was repaired with transosseous tunnel fixation in 22 patients (transosseous tunnel fixation group) and with drilling fixation in 28 patients (drilling fixation group). There was no significant difference between the two groups (P>0.05) in gender, age, fracture side, time from injury to admission, coronoid process fracture classification, radial head fracture classification, and TTE classification. The operation time, intraoperative blood loss, fracture healing time, and complications of the two groups were recorded. At last follow-up, the Mayo elbow performance system (MEPS) score, range of motion of elbow joint, and Broberg-Morrey classification were recorded.ResultsThe operation of two groups were successfully completed. There was no significant difference in the operation time and intraoperative blood loss between the two group (P>0.05). The follow-up time was (24.43±6.84) months in the transosseous tunnel fixation group and (21.55±6.16) months in the drilling fixation group, and the difference was not significant (t=1.534, P=0.132). X-ray films showed that the coronoid process and radial head fractures in the two groups healed, and there was no significant difference in the healing time (P>0.05). At last follow-up, there was no significant difference in the flexion-extension activity, rotation activity, MEPS score, and Broberg-Morrey grading (P>0.05). During the follow-up, there was no re-dislocation or instability of the elbow joint. The incidence of complication was 28.57% (8/28) in the transosseous tunnel fixation group and 27.27% (6/22) in the drilling fixation group, showing no significant difference (χ2=2.403, P=0.121).ConclusionBoth transosseous tunnel fixation and drilling fixation can achieve good results in repair of LCLC for TTE.
ObjectiveTo investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow.MethodsRetrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score.ResultsThe operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides (P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%.ConclusionFor patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness.
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.