Comparative Analysis of Mason Type Ⅱ Radial Head Fracture Area and the Safe Zone
1.Department of Orthopedics,the Second Clinical Medical College,Shanxi Medical University
2.Department of Orthopedics,the Second Hospital of Shanxi Medical University
3.Ambulatory Surgery Department,the Second Clinical Medical College,Shanxi Medical University
Abstract:Objective To mesure the fracture area of Mason type Ⅱ radial head fractures using three-dimensional reconstruction and compare the relationship with the safe zone.Methods We collected forty patients (31 males and 9 females),which aged from 18 to 69 years old,with an average of (38±13)years old.The patients were diagnosed of radial head fractures in the Second hospital of Shanxi Medical University between January 2015 and September 2018.The 3D models of radial head fractures were created.We assumed the articular surface of the radial head to be a circal,and the start angle,end angle and fracture area of the radial head were measured by three separate observers in each case,and the data were statistically analyzed.We divided the fitting circle according to a clock face of 360°,with every interval of 10° considered a sector.The averages of the start angle,end angle,fracture area,and bisector angle of the fracture area of the radial head were calculated,and their relationships with the safe zone (110°) were determined.Results We found 30° to 120° as the common fracture area of Mason type Ⅱ radial head fractures,with 39% (35°) in the safe zone and 61% (55°) not in the safe zone.No patient had involvement in any sector among the six intervals between 210° and 270°,we considered this area to be the rare fracture area.We regarded the area from 2°~153° as the average fracture area of Mason type Ⅱ radial head fractures.In the average fracture area,42% (63°) was in the safe zone and 58%(88°) was not.Conclusion Mason type Ⅱ radial head fracture area is mainly located in the anterolateral and anteromedial,while the safe zone is located in the anterolateral and posterolateral.It is proved that the fracture of radial head often involves the unsafe area.It provides intuitive guidance for clinicians to choose suitable therapeutic treatment and internal fixator.
聂志豪 1,杨朝晖 2*,聂博渊 3. MasonⅡ型桡骨小头骨折区域和安全区对比分析[J]. 实用骨科杂志, 2021, 27(12): 1087-1101.
Nie Zhihao 1,Yang Zhaohui 2,Nie Boyuan 3. Comparative Analysis of Mason Type Ⅱ Radial Head Fracture Area and the Safe Zone. sygkzz, 2021, 27(12): 1087-1101.
[1]Van Riet RP,Van den Bekerom MPJ,Van Tongel A,et al.Radial head fractures[J].Shoulder Elbow.2020,12(3):212-223.
[2]Li N,Chen S.Open reduction and internal fixation versus radial head replacement in treatment of Mason type Ⅲ radial head fractures[J].Eur J Orthop Surg Traumatol,2014,24(6):851-855.
[3]Smith GR,Hotchkiss RN.Radial head and neck fractures:anatomic guidelines for proper placement of internal fixation[J].J Shoulder Elbow Surg,1996,5(2):113-117.
[4]Capo JT,Shamian B,Francisco R,et al.Fracture pattern characteristics and associated injuries of high-energy,large fragment,partial articular radial head fractures:a preliminary imaging analysis[J].J Orthop Traumatol,2015,16(2):125-131.
[5]Mellema JJ,Eygendaal D,van Dijk CN,et al.Fracture mapping of displaced partial articular fractures of the radial head[J].J Shoulder Elbow Surg,2016,25(9):1509-1516.
[6]Van Leeuwen DH,Guitton TG,Lambers K,et al.Quantitative measurement of radial head fracture location[J].J Shoulder Elbow Surg,2012,21(8):1013-1017.
[7]Hutchinson HL,Gloystein D,Gillespie M.Distal biceps tendon insertion:an anatomic study[J].J Shoulder Elbow Surg,2007,17(2):342-346.
[8]Caputo AE,Mazzocca AD,Santoro VM.The nonarticulating portion of the radial head:Anatomic and clinical correlations for internal fixation[J].J Hand Surg Am,1998,23(6):1082-1090.
[9]Zhan Y,Luo CF,Chen YJ.A new method to locate the radial head “safe zone” on computed tomography axial views[J].Orthop Traumatol Surg Res,2018,104(1):71-77.
[10]Captier G,Canovas F,Mercier N,et al.Biometry of the radial head:biomechanical implications in pronation and supination[J].Surg Radiol Anat,2002,24(5):295-301.
[11]O’Driscoll SW,Morrey BF,Korinek S,et al.Elbow subluxation and dislocation.A spectrum of instability[J].Clin Orthop Relat Res,1992(280):186-197.
[12]Haverstock JP,Katchky RN,Lalone EA,et al.Regional variations in radial head bone volume and density:implications for fracture patterns and fixation[J].J Shoulder Elbow Surg,2012,21(12):1669-1673.
[13]Couture A,HébertDavies J,Chapleu J,et al.Involvement of the proximal radial ulnar joint in partial radial head fractures:a novel three-dimensional computed tomography scan evaluation method[J].Shoulder Elbow,2019,11(2):121-128.
[14]King GJ,Richards RR,Zuckerman JD,et al.A standardized method for assessment of elbow function.Research committee,American shoulder and elbow surgeons[J].J Shoulder Elbow Surg,1999,8(4):351-354.
[15]Desloges W,Louati H,Papp SR,et al.Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval[J].J Bone Joint Surg(Am),2014,96(5):387-393.
[16]Schimizzi A,MacLennan A,Meier KM,et al.Defining a safe zone of dissection during the extensor digitorum communis splitting approach to the proximal radius and forearm:An anatomic study[J].J Hand Surg Am,2009,34(7):1252-1255.
[17]Han F,Teo AQ,Lim JC,et al.Outcomes using the extensor digitorum communis splitting approach for the treatment of radial head fractures[J].J Shoulder Elbow Surg,2016,25(2):276-282.
[18]陈鹏,傅德皓.Herbert螺钉与钢板治疗MasonⅡ型桡骨小头骨折临床分析[J].实用骨科杂志,2015,21(2):160-162.
[19]汪勇刚,王敏.三种不同内固定方案治疗成人MasonⅡ型桡骨小头骨折的效果[J].中国医药导报,2019,16(6):68-71.