Abstract：Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures. Methods From August 2007 to November 2011, 16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors. There were 11 men and 5 women with a mean age of 31.6 years (range, 18-52 years). Totally, left side was involved in seven cases and right side in nine; dominant side was involved in 13 cases and non-prominent side in three. Time from injury to operation averaged 6.2 days (range, 2-11 days). Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO mini-screws and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction. Active and assisted functional exercise was instructed in the early period after surgery. Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up. Results Follow-up averaged 22.6 months (range, 12-38 months), which showed primary wound healing without infection. All fractures achieved bony union at an average of 4.8 months (range, 3.3-6.2 months). Ten out of the 16 cases, four of partial articular fractures and six of complete articular fractures, had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment. There were two excellent, six good and one fair results in partial articular fracture group, with excellent-good rate of 89% as well as one excellent, four good and two fair results in complete articular fracture group, with excellent-good rate of 72%. Moreover, the total excellent-good rate reached 81%. Range of motion in extension, flexion and rotation, Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P<0.05). Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint, favors early functional exercise and further decreases incidence of postoperative complications, such as elbow stiffness, pain and heterotopic ossification.
XIANG Ming,YANG Guo-yong,CHEN Hang et al. One-stage repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(7): 628-632.
［1］Gurd FB. Surplus parts of the skeleton: a recommendation for the excision of certain portions as a means of shortening the period of disability following trauma. Am J Surg, 1947, 74(5):705-720.
［2］Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J, 1962, 31(1):51-56.
［3］Frankle MA, Koval KJ, Sanders RW, et al. Radial head fractures associated with elbow dislocations treated by immediate stabilization and early motion. J Shoulder Elbow Surg, 1999, 8(4):355-360.
［5］Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg (Am), 1986, 68(5):669-674.
［6］Sotereanos DG, Darlis NA, Wright TW, et al. Unstable fracture-dislocations of the elbow. Instr Course Lect, 2007, 56:369-376.
［7］Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res, 1991, (265):187-195.
［8］Sjbjerg JO, Ovesen J, Nielsen S. Experimental elbow instability after transection of the medial collateral ligament. Clin Orthop Relat Res, 1987, (218):186-190.
［9］Hotchkiss RN, Weiland AJ. Valgus stability of the elbow. J Orthop Res, 1987, 5(3):372-377.
［10］Dunning CE, Zarzour ZD, Patterson SD, et al. Ligamentous stabilizers against posterolateral rotator instability of the elbow. J Bone Joint Surg (Am)，2001, 83(12):1823-1828.
［11］Morrey BF. Radial head fracture∥Morrey BF. The elbow and its disorders. 3rd ed. Philadelphia: W B Saunders, 2000:341-364.
［12］Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. J Bone Joint Surg (Am), 1995, 77(2):316-327.
［13］van Riet RP, Morrey BF, O’Driscoll SW, et al. Associated injuries complicating radial head fractures: a demo-graphic study. Clin Orthop Relat Res, 2005， (441):351-355.
［14］Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect, 1995, 44:175-185.
［15］Browner BD, Levine AM, Jupiter JB, et al. Trauma to adult elbow in skeletal trauma: basic science, management, and reconstruction. 3rd ed. Philadelphia: W.B. Saunders, 2003:1405-1415.
［16］O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg (Am), 1991, 73(3):440-446.
［18］Winter M, Chuinard C, Cikes A, et al. Surgical management of elbow dislocation associated with non-reparable fractures of the radial head. Chir Main, 2009, 28(3):158-167.
［19］Linscheid RL. Elbow dislocations∥Morrey BF. The elbow and its disorders. 1st ed. Philadelphia: WB Saunders, 1985:414-432.
［20］Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg (Am), 2002, 84(4):547-551.
［21］Weseley MS, Barenfeld PA, Eisenstein AL. Closed treatment of isolated radial head fractures. J Trauma, 1983, 231(1):36-39.
［22］Melhoff TL, Noble PC, Bennet JB, et al. Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg (Am), 1988, 70(2):244-249.
