Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures

Abstract

Purpose: The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method - a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws.

Methods: From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups.

Results: In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups.

Conclusion: The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.

Keywords: clinical efficacy; fracture; mini-open; radial head; screw.

Figure 1

Exclusion criteria.

Figure 2

Surgical technique applied to a 27-year-old male patient with Mason type II fracture. (A) Mark of the incision location preoperation; (B) Preoperative fluoroscopy to locate the incision; (C) Exposure of the fracture region and insertion of the screws; (D) Photo of incision postoperation.

Figure 3

Different screw fixation methods were used for fixation of different types of fractures. (A) Schematic diagram of intraoperative posture and mini-open incision. (B) Two main surgical approaches in our study: mini-open Kocher approach and mini-open Kaplan approach. (C) Single screw only for Mason type II fractures and the fracture block is small. (D) Two screws are required when the bone is large. (E) When a Mason type III fracture has two small fracture blocks, the first screw is used to fix two small blocks into one piece, and the other is used to fix the block to the radial head. (F) When a Mason type III fracture has two fracture blocks, one of which is larger, the first screw is used to fix the two blocks into one piece, and the others are used to fix the block to the radial head.

Figure 4

The comparison between novel group and conventional group. (A) Blood loss in operation; (B) Operative time; (C) Hospital stay; (D) Interval between injury and surgery; (E-G) ROM of elbow; (H) VAS score; (I) MEPS score; (J) ASES score; (K) Q-DASH score.

Figure 5

Male, 23 years with fracture type II who underwent ORIF by novel approach: (A and B): X-ray and 3D-CT images after injury showing a Mason type II fracture; (C): X-ray at 6 months postoperation showing healing of the fracture; (D-G): The ROM of shoulder at 6 months postoperation.