The clinical efficacy of the minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails

Abstract

Radial head fractures (RHFs) occur most frequently among all elbow fractures. Current treatments pose several limitations for the Mason type II radial head fractures. This study was performed to evaluate the clinical efficacy of a new minimally invasive treatment for Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails. Between January 2018 and December 2019, our group used double titanium elastic intramedullary nails as a minimally invasive treatment for 32 cases of Mason II type radial head fractures. After the treatments, we summarized and conducted a retrospective analysis to evaluate the surgical operation itself, the quality of the fracture reductions, the fracture healing, and any complications. The Mayo elbow function scores (MEPS) and the visual analog scale (VAS) pain scores were used to evaluate the clinical efficacy of this approach. All the patients recovered from their surgeries without any complications. We followed all the cases for an average of 12 months. The elbow extension range of motion was 5 degrees (range: 0-15 degrees), the elbow flexion range of motion was 140 degrees (range: 135-146 degrees), and the average forearm pronation range of motion was 84.1 degrees (range: 78-90 degrees). The average forearm supination range of motion was 80.4 degrees (range: 75-85 degrees). All the fractures healed (a 100% healing rate), the MEPS score was 96.7 (range: 85-100), and the MEPS ratings of excellent and good were both 100%. The VAS pain scores ranged from 0-1. The minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double elastic nails proved to be a simple approach with a relatively short operation time. It required only a small incision with little trauma and had few complications, so it is worth consideration for wider use.

Keywords: Mason type II; Radial head fractures; clinical efficacy; double titanium elastic nails; intramedullary fixation; minimally invasive.

Figure 1

Preoperative patient imaging data. A 31-year-old female patient with a Mason type II fracture of the right radial head that was caused by a falling injury. The preoperative X-ray showed a radial head fracture in the anteroposterior (A) and lateral (B) positions, with a significant displacement of the fracture site. The preoperative CT, sagittal (D), coronal (E) and three-dimensional reconstruction (C, F) confirmed that the radial head fracture had fracture fragments displaced anterolaterally with joint surface irregularity (The red arrow illustrates the position of the radial head fracture site).

Figure 2

Intraoperative X-ray monitoring of the elastic titanium nail implantation process and fracture reduction. A. An intraoperative X-ray showed that a single elastic titanium nail reached the radial neck through the medullary cavity, and the fracture site was still displaced. B. After tapping the nail tail, the elastic titanium nail passed through the radial neck to the radial head, which allowed for a prying reduction of the fracture site. However, there remained some unevenness of the articular surface. C. The anteroposterior X-ray showed that after the second elastic titanium nail was used to fix the fracture, the two elastic titanium nail tips were opened and held up to maintain the anatomical reduction of the fracture. D. The lateral X-ray showed that the fracture site of radial head had been anatomically reduced, and the position of the two elastic titanium nails was satisfactory (The red arrow illustrates the position of radial head fracture site).

Figure 3

X-ray examination on the second day after the operation. A, B. X-ray anteroposterior and lateral views showed that after the intramedullary fixation with two elastic titanium nails, the fracture site of the radial head was anatomically reduced, and the elastic titanium nail was in a good position. C, D. Three months after the operation, the X-rays showed that the fracture line of the radial head was blurred, the fracture was completely healed, and the positions of the two elastic titanium nails were good, without any signs of loosening or fracture (The red arrow illustrates the position of the radial head fracture site).

Figure 4

The patient’s elbow function after the operation. On the second day after the operation, the elbow joint had good supination (A), pronation (B), extension (C), and flexion (D).