소형 금속판을 이용한 요골두 분쇄골절의 치료

Abstract

Purpose: The recommended treatment of displaced or comminuted radial head fracture has been excision with or without prosthesis replacement. Excision of radial head will result in valgus deformity, and proximal migration of radius. Long term follow up of prosthesis also can induce valgus instability, synovitis, dislodging or wearing of prosthesis. This study presents the clinical reports of open reduction and internal fixation with miniplate and screws. Materials and Methods: From May 1999 to October 2002, 10 patients with Mason type III (7 cases), type IV (3 cases) were treated with mini-plate and screws. Operative indication were head and neck dissociation fracture, fracture extended to radial tuberosity, children’s fracture, dominant side Mason type III, IV injury of highly young active patient. The patients were 7 males and 3 females. Average age was 32 years (14∼4 8 years). Average follow up period was 15.8 months. All fractures were tried to fix at the safe zone with straight, T or L shape miniplate. Extracorporeal reduction of radial head was done in 4 cases. Additional fixation was done in 7 cases. Herbert’s screw was used in 3 cases, mini-screw in 4 cases, buried K-wires in five cases. Only mini-plate and screws was used in one case. Auto distalradial bone graft to the neck was done in one case. Average duration of immobilization was 4 weeks (3∼6 weeks). Removal of internal fixation was done in three cases and second stage arthrolysis was done in two cases. Results: At the last follow up, average range of motion was 9°∼123°, 58°in pronation and 55°in supination. By the functional rating index (Modified after B.F.Morrey et al.), 3 cases were excellent, 4 cases were good, and 1 case was fair, 2 cases were poor. Each case of K-wire migration, nonunion in neck and partial avascular necrosis of head was developed. But there were no discomfort of ADL. The result of Mason type III was better than type IV. Conclusion: Open reduction and plate fixation of radial head fracture is recommended for head and neck dissociation fracture or extended fracture line to the radial tuberosity, children’s fracture and dominant side of Mason type III, IV fracture in highly young active patient