[Instability after operative and conservative treatment of isolated Mason type II fractures].
Instabilität nach operativer und konservativer Versorgung von isolierten Mason-II-Frakturen.
Complications
Elbow osteoarthritis
Elbow instability
Mason II
Radial head
Journal
Der Unfallchirurg
ISSN: 1433-044X
Titre abrégé: Unfallchirurg
Pays: Germany
ID NLM: 8502736
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
pubmed:
4
5
2018
medline:
14
9
2019
entrez:
4
5
2018
Statut:
ppublish
Résumé
Radial head fractures are the most frequent fractures of the elbow joint in adults. For Mason type II fractures without concomitant injuries favorable results have been shown with operative and conservative management. There is insufficient evidence concerning elbow joint stability after conservative treatment compared to open reduction and internal fixation (ORIF). All patients with isolated Mason type II (two part fracture displaced >2 mm and <5 mm) radial head fractures between 1 January 2003 and 1 April 2013 were retrospectively reviewed. Exclusion criteria were age <18 years, associated fractures of the ipsilateral extremity or elbow luxation. A total of 50 patients (mean age 44.2 years, range 19-71 years) who received either ORIF (n = 31) or conservative treatment (n = 19) were included. The mean follow-up was 43.2 months (range 9-61 months). Patients were evaluated using the Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance score (MEPS), and Oxford Elbow score (OES). Joint stability (varus and valgus stress) was assessed under fluoroscopy and a distinction was made between slight instability (angulation <10°), moderate instability (angulation ≥10°) and gross instability (elbow dislocation). Residual fracture displacement (conservative: 2.7 mm, ORIF: 1.4 mm, p < 0.042) and varus/valgus joint stability (3% ORIF vs. 26% conservative, p = 0.031) showed significant differences. The stability as tested by a radiological dynamic procedure showed an instability after ORIF in 3% of the joints compared to 26% after conservative treatment; however, this did not influence the short to mid-term clinical outcome: No significant differences were found in the DASH score (conservative 33 points, ORIF 36 points), MEPS (conservative 76 points, ORIF 78 points) and OES (conservative 41 points, ORIF 43 points). Both conservative management and operative treatment had a good functional outcome. Operative treatment showed a positive tendency concerning radiological and functional outcome without statistical significance.
Sections du résumé
BACKGROUND
BACKGROUND
Radial head fractures are the most frequent fractures of the elbow joint in adults. For Mason type II fractures without concomitant injuries favorable results have been shown with operative and conservative management. There is insufficient evidence concerning elbow joint stability after conservative treatment compared to open reduction and internal fixation (ORIF).
MATERIALS AND METHODS
METHODS
All patients with isolated Mason type II (two part fracture displaced >2 mm and <5 mm) radial head fractures between 1 January 2003 and 1 April 2013 were retrospectively reviewed. Exclusion criteria were age <18 years, associated fractures of the ipsilateral extremity or elbow luxation. A total of 50 patients (mean age 44.2 years, range 19-71 years) who received either ORIF (n = 31) or conservative treatment (n = 19) were included. The mean follow-up was 43.2 months (range 9-61 months). Patients were evaluated using the Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance score (MEPS), and Oxford Elbow score (OES). Joint stability (varus and valgus stress) was assessed under fluoroscopy and a distinction was made between slight instability (angulation <10°), moderate instability (angulation ≥10°) and gross instability (elbow dislocation).
RESULTS
RESULTS
Residual fracture displacement (conservative: 2.7 mm, ORIF: 1.4 mm, p < 0.042) and varus/valgus joint stability (3% ORIF vs. 26% conservative, p = 0.031) showed significant differences. The stability as tested by a radiological dynamic procedure showed an instability after ORIF in 3% of the joints compared to 26% after conservative treatment; however, this did not influence the short to mid-term clinical outcome: No significant differences were found in the DASH score (conservative 33 points, ORIF 36 points), MEPS (conservative 76 points, ORIF 78 points) and OES (conservative 41 points, ORIF 43 points).
DISCUSSION
CONCLUSIONS
Both conservative management and operative treatment had a good functional outcome. Operative treatment showed a positive tendency concerning radiological and functional outcome without statistical significance.
Identifiants
pubmed: 29721653
doi: 10.1007/s00113-018-0504-9
pii: 10.1007/s00113-018-0504-9
doi:
Types de publication
Journal Article
Langues
ger
Sous-ensembles de citation
IM
Pagination
219-224Références
J Shoulder Elbow Surg. 1999 Nov-Dec;8(6):612-6
pubmed: 10633898
J Bone Joint Surg Am. 2000 Apr;82(4):555-60
pubmed: 10761945
Instr Course Lect. 2001;50:89-102
pubmed: 11372363
Clin Biomech (Bristol, Avon). 2003 Aug;18(7):677-81
pubmed: 12880716
Br J Surg. 1954 Sep;42(172):123-32
pubmed: 13209035
Ann Rheum Dis. 1957 Dec;16(4):494-502
pubmed: 13498604
J Orthop Trauma. 1992;6(3):283-9
pubmed: 1403245
Anat Rec. 1964 Nov;150:243-7
pubmed: 14227963
Ulster Med J. 1962 Jun 1;31:51-6
pubmed: 14452145
J Bone Joint Surg Am. 2004 Mar;86-A(3):569-74
pubmed: 14996884
J Shoulder Elbow Surg. 2005 May-Jun;14(3):312-7
pubmed: 15889032
J Shoulder Elbow Surg. 2005 Jul-Aug;14(4):421-4
pubmed: 16015243
BMC Musculoskelet Disord. 2006 May 18;7:44
pubmed: 16709254
J Bone Joint Surg Am. 2006 Sep;88(9):1909-14
pubmed: 16951104
J Bone Joint Surg Br. 2008 Apr;90(4):466-73
pubmed: 18378921
J Trauma. 2009 Jul;67(1):143-6
pubmed: 19590324
J Hand Surg Am. 2009 Nov;34(9):1729-33
pubmed: 19896014
J Shoulder Elbow Surg. 2010 Jun;19(4):520-3
pubmed: 20149972
J Trauma. 2011 Sep;71(3):643-8
pubmed: 21248649
Open Orthop J. 2011;5:168-76
pubmed: 21633722
J Hand Surg Am. 2012 Jan;37(1):112-9
pubmed: 22119600
J Shoulder Elbow Surg. 2012 Jun;21(6):789-94
pubmed: 22521392
J Hand Surg Am. 2012 Jul;37(7):1416-21
pubmed: 22622090
Unfallchirurg. 2015 Jan;118(1):9-17
pubmed: 24452244
Clin Orthop Relat Res. 2014 Jul;472(7):2105-12
pubmed: 24577616
J Orthop Surg Res. 2015 Aug 20;10:128
pubmed: 26289111
BMC Musculoskelet Disord. 2017 Feb 20;18(1):85
pubmed: 28219360
Acta Orthop Scand. 1987 Dec;58(6):649-51
pubmed: 3442212
Am J Sports Med. 1983 Sep-Oct;11(5):315-9
pubmed: 6638246