Radial head and neck fractures

Detta är en avhandling från Pär Herbertsson, Ortop klin, UMAS, 205 02 Malmö

Sammanfattning: All elbow fractures between 1969 – 1979 (n=2965) registered at the radiographic archives at the Malmö University Hospital, where all radiographs are saved since a century, were evaluated. Fractures of the radial head and neck were classified according to the by Broberg and Morrey modified Mason classification. A Mason type I fracture is a less than 2 mm displaced fracture of the radial head or neck, a Mason type II fracture is a 2 mm or more displaced fracture, a Mason type III fracture is a comminuted fracture and a Mason type IV fracture is a radial head or neck fracture in addition with an elbow dislocation. Radial head or neck fractures were found in 756 individuals, in 480 (64%) a Mason type I fracture, in 222 (29%) a Mason type II fracture, in 36 (5%) a Mason type III fracture and in 18 (2%) a Mason type IV fracture. The annual incidence of radial head and neck fractures were 2.6 out of 10 000 in all individuals, 2.9 out of 10 000 in adults and 1.4 out of 10 000 in children. As to increase the sample size, when evaluating individuals with a Mason type IV fracture and individuals treated with an extirpation of the radial head, we included individuals found in the out- and in clinic registers and the operation registers during the years 1957 – 1990. All former patients, still living in Malmö, were after mean 11 – 46 years subjectively, objectively and radiographically re-evaluated. The 32 individuals with a displaced Mason type I fractures had all with conservative treatment predominantly a favourable outcome, no objective deficits, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow osteoarthritis (OA). The 22 children (below age 16) with a Mason type II or III fracture had a predominantly favourable outcome, an impaired flexion but no higher prevalence of radiographical degenerative changes or elbow OA, when a reduction of the fracture was undertaken if the fractured radial head was tilted more than 30 degrees. The 100 adults (16 years or older) with a Mason type II or III fracture had a predominantly acceptable outcome, an impaired flexion and extension, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow OA, if a late radial head excision was undertaken in cases with an unfavourable primary outcome. There were no differences in subjective, objective and radiographical outcome when comparing 43 individuals treated with a primary radial head excision with 18 individuals treated with a delayed radial head excision following a Mason type II – IV fracture. The 21 individuals with a Mason type IV fracture seemed to have a trend towards a higher proportion of unsatisfied individuals when compared with a Mason type I - III fracture. Although the majority still had an acceptable outcome, an impaired flexion and extension, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow OA, and none had experienced recurrent elbow dislocations.

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