Mason Type Research Articles

Clinical significances of associated injuries of radial head fracture

Objective To explore the relationship between a radial head fracture and its associated injuries and the effect of associated injuries on the treatment. Methods We retrospectively analyzed the patients with radial head fracture who had been treated from December 2013 to December 2015. The data of their gender, age, laterality, traumatic mechanisms, Mason classification of the fracture, associated injuries, and therapeutic methods were documented. Single factor correlation analysis was conducted to identify the relationship between Mason classification and number of associated injuries, and the effects of age, Mason classification and number of associated injuries on the therapeutic methods. Results The study cohort was comprised of 61 patients, including 32 men and 29 women with a male to female ratio of 1. 1∶1. They were 20 to 78 years of age(average, 40 years). Thirty-one cases had the left elbow affected, 29 the right elbow, and one bilateral elbows. There were 17 cases of Mason Type I, 30 ones of Mason Type Ⅱ, 9 ones of Mason Type Ⅲ, and 5 ones of Mason Type Ⅳ. Ligamentous injury was associated in 47 patients, coronoid fracture in 5, distal humeral fracture in 5, capitellum osteochondral defect in 17, olecranon fracture in 2, and proximal radioulnar fracture in 2. Thirty-three patients had nonoperative treatment; 26 patients received open reduction and internal fixation; one patient underwent resection; radial head replacement was used in one. Single factor correlation analysis revealed no significant associations between number of associated injuries and gender, age, or laterality(P> 0. 05), a positive correlation between severity of radial head fracture(Mason classification)and incidence of associated injuries(P< 0. 05), and significant relationships between choice of therapy and age, Mason classification and number of associated injuries(P< 0. 05). Conclusions There may be a significant relationship between the Mason type and number of the associated injuries. The more severe a radial head fracture, the more associated injuries. Age, Mason classification, and number of associated injuries may affect the choice of therapeutic methods. In the treatment of radial head fractures, associated injuries must be considered carefully to minimize their impact. The therapy should depend on the associated injuries. Key words: Elbow joint; Radial fractures; Associated injuries; Traumatic mechanisms

Clinical Relevance Commentary in Response to: Coaching of patients with and isolated minimally displaced fracture of the radial head immediately increases range of motion

Even a minor injury occurring at the elbow can result in limitations in elbow active range of motion (AROM). 18 Sardelli M. Tashjian R.S. MacWilliams B.A. Functional elbow range of motion for contemporary task. J Bone Joint Surg Am. 2011; 93: 471-477 Crossref PubMed Scopus (150) Google Scholar , 21 Morrey B.F. An K.N. Functional evaluation of the elbow. in: Morrey B.F. The Elbow and Its Disorders. 3rd ed. WB Saunders, Philadelphia, PA2000: 74-83 Google Scholar It is widely accepted that patient participation in a home program has been an integral component of therapy to facilitate improvements in motion, function, and reduction of pain. My clinical experience is consistent with the finding that patients with Broberg-Morrey–modified Mason type 1 or 2 fracture 1 Broberg M.A. Morrey B.F. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res. 1987; 216: 109-119 PubMed Google Scholar of the radial head or the neck often may have reports of pain, stiffness, swelling, limited AROM, and limitations in function immediately after the period of initial nonoperative treatment of rest. I concur that patients typically show some improvement in AROM on the same day when the protection of a sling/splint is discontinued, are instructed in safe parameters of exercise, and have the opportunity to demonstrate correct exercise and activity performance.

Functional Outcomes of Fixation Versus Replacement for Comminuted Radial Head Fractures in Adults: A Systematic Review

Aim : The purpose of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. Material and Methods : A comprehensive search of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed. Results : Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion. Conclusion : Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision-making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution.

The yield of subsequent radiographs during nonoperative treatment of radial head and neck fractures

After diagnosis of an isolated radial head or neck fracture and selection of nonoperative treatment, the value of subsequent radiographs is uncertain. This study tested the null hypothesis that there are no patient, surgeon, or injury factors associated with alteration in patient management based on subsequent radiographs. Secondarily, we tested the null hypothesis that the use of subsequent radiographs is not associated with patient, surgeon, and fracture characteristics. We identified 415 adult patients with nonoperative treatment for isolated Broberg and Morrey modified Mason type 1 or 2 fractures at a large urban hospital system during years 2013 and 2014. Patient demographics, fracture characteristics, provider characteristics, and treatment details were obtained from a hospital database. Bivariate analysis and multivariable logistic regression modeling were performed. One of 255 patients with 262 fractures that had subsequent radiographs (0.4%) was offered surgery but declined. In multivariable analysis, displaced fractures were more likely to have subsequent radiographs, but surgeon-to-surgeon variation was a far more influential factor. Radiographs subsequent to diagnosis do not alter treatment of radial head fractures with no associated ligament injuries or fractures. The substantial surgeon-to-surgeon variation in the use of subsequent radiographs suggests that this may be a good focus for quality improvement initiatives.

Results of screw fixation in Mason type II radial head fractures

PurposeThe treatment of Mason type II fractures is controversial, and the aim of our study is to define the outcome of surgical treatment with screw fixation in the Mason type II radial head fracture.MethodsThe study was carried out between 2011 and 2015, and included 14 men and 9 women, with isolated Mason type II radial head fractures which were treated operatively with screw fixation. Cases involving the additional ligament injury or fractures in other areas, or having a follow-up period which is greater than 11 months were excluded. The clinical and radiological results of our patients were assessed, using the Mayo Elbow Performance Score (MEPS).ResultsThe average MEPS was 95.86 points. 100 degree arcs of motion were attained by a total of 21 patients (91 %) for both flexion–extension and pronation–supination. Nevertheless, 2 patients (9 %) did not recover the 100 degree arcs for the flexion–extension.ConclusionAnatomical reduction of type II radial head fractures through open surgery and fixation with screws can have favorable results.Level of evidenceLevel IV, Retrospective design.

Mason type 3 radial head fractures: proposal of a synthesis technique using bioabsorbable thread.

Multifragmentary fractures of the radial head (Mason type 3) are challenging for the surgeon. They are usually treated by means of complete removal of the injured head and sometimes by implantation of a metal prosthesis. Indeed, the bone fragments are often too small to allow stabilization through screws or even wires. The Author proposes an alternative technique, tested on a sawbone model, in which bioabsorbable thread is used, introduced in a figure-of-eight fashion. A review of the literature is provided.

Radial Head Arthroplasty with A Modular Prosthesis – Initial Experience

Summary The Mason type III and IV radial head fractures are severe injuries that lead to decreased range of motion, alteration in the kinematics, the load transfer and the stability of the elbow. They are often in conjunction with ligament injuries, anterior or posterior joint dislocations and fractures of the coronoid process, the humeral capitulum and the olecranon. The resection of the head leads to elbow instability, late complications and arthrosis of the elbow. The open reduction and internal fixation (ORIF) in Mason type III and IV fractures is not able to restore and sustain the anatomical structure and function of the radiocapitellar joint. That is why these fractures require arthroplasty. The best results are reported with the use of metal bipolar prosthetics. We present our initial experience with radial head arthroplasty on three patients with mean follow up 18 months and a review of the English literature.

Scaphoid fracture combined with triangular fibrocartilage injury and radial head fracture: a new type of forearm injury triad

Objective To introduce a new triad of forearm injury: scaphoid fracture, triangular fibrocartilage (TFC) injury and radial head fracture, and discuss the similarities and differences comparing to Essex-Lopresti injury. Methods Six male patients of closed forearm injuries treated from October 2011 to May 2013 were involved in this study. They all had scaphoid and radial head fractures on the same side. Wrist arthroscopic examination was carried out in 3 cases that revealed injury to the radial rim of the TFC. One case had olecranon fracture on the contralateral side, while 5 cases had no other accompanying fractures.Two cases were non-surgically treated, while 4 cases were surgically managed where the scaphoid fracture was treated with percutaneous compressive cannulated screw fixation, and the laceration or perforation at the radial rim of the TFC revealed under wrist arthroscopy in 3 cases was treated with arthroscopic debridement. The radial head fracture in 3 cases was categorized as Mason type Ⅰ and treated with splint immobilization. Open reduction and internal fixation was used in 1 case of Mason type Ⅱ radial head fracture. Results All 6 patients were follow-up for 12 to 24 months. The mean follow-up period was 17 months. Fracture union was achieved in all six patients. Clinical evaluations using modified Mayo wrist scoring system and modified Morrey elbow score revealed excellent wrist and elbow functional results in all the patients. Conclusion Comparing to the typical Essex-Lopresti injury, the reported new triad of forearm injury has subtler clinical manifestations due to the relatively low energy impact despite of the similar injury mechanisms. Consequently, misdiagnosis or missed diagnosis is more likely to happen. Successful outcomes rely on prompt diagnosis and proper treatment. Key words: Scaphoid bone; Radius; Fractures, bone; Triangular fibrocartilage

Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis

Open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) are the most common operative treatments in patients with radial head fractures. The purpose of this study was to determine the efficacy of RHA and ORIF treatments in patients with radial head fractures (modified Mason type III and IV). We conducted a computerized search of five electronic databases from their inception to July 2015. All clinical trials comparing ORIF versus RHA treatment in patients with radial head fractures were included. We evaluated the primary outcomes included elbow functional evaluation criteria by Broberg and Morrey, elbow score (Broberg and Morrey), Mayo Elbow Performance Score (MEPS) and QuickDASH score. Secondary outcomes included Visual Analog Scale (VAS), range of motion, operation time and complications. The "assessing risk of bias" table was applied to assess the risk of bias of the included studies. Eight studies were included in this meta-analysis, which consisted of 138 cases of ORIF and 181 RHA. Methodological quality of the studies was moderate to low. RHA afforded significantly higher satisfaction rate, better elbow score (Broberg and Morrey) and MEPS, shorter operation time, lower incidence of bone nonunion or absorption and internal fixation failure when compared to ORIF. There were no significantly differences in QuickDASH score and other complications. RHA has better outcome in patients with radial head fractures (modified Mason type III and IV) than ORIF with medium-short-term follow-up period, but longer-term studies will be required to ascertain whether the apparent benefits of RHA were offset by late complications. Therapeutic decision analysis; a meta-analysis, Level III.

Treatment of fracture of radial head combined with bony instability around the elbow

Objective To investigate the therapeutic strategies of radial head fracture combined with bony instability around the elbow. Methods From January 2003 to June 2011, 31 patients with radial head fracture combined with bony instability around the elbow were treated. They were 21 males and 10 females, from 20 to 65 years of age (average, 42.6 years). Ulnar coronoid process fracture was found in 11 patients, ulnar olecranon fracture in 14 and capitellum fracture in 6. The radial head fracture was Mason type Ⅱ in 13 patients and Mason type Ⅲ in 18. All patients with radial head fracture were treated with mini-plate or screws. The 3 cases of ulnar coronoid process fracture of typeⅠ received conservative treatment when there was no displaced fracture fragment, or surgery after removal of the fragments in the joint and suture of the capsule. The 7 cases of type Ⅱand type Ⅲ fractures received internal fixation with Kirschner wire or micro-plate after the anterior bundle of the ulnar collateral ligaments (UCL) were repaired. Bone and ligament reconstructions were necessary to rebuild elbow stability in one patient with type Ⅳ fracture. For the ulna olecranon fractures, Kirschner wire with tensile band was used in non-comminuted ones, or plate and screw fixation and bone graft in the 6 comminuted ones. The 6 cases of type I capitellum fracture were treated with compression screw fixation. Results All wounds healed at the primary stage. All fractures united after 3 to 6 months (average, 5.1 months). All the patients were followed up for 18 to 36 months (average, 24.3 months). Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification in 4. The mean range of motion (ROM) of the affected elbow joint was 104°, and the ROM of forearm rotation was 118°. According to Broberg & Morrey evaluation system, the elbow function was rated as excellent in 7 patients, good in 15, fair in 6 and poor in 3. The excellent and good rate was 71.0% . Conclusions In order to achieve good functional restoration of the elbow joint, the radial head fractures should be anatomically reduced and internally fixated with mini-plate or screws. Injury to the bony structures around the elbow, such as ulnar coronoid process fracture, ulnar olecranon fracture and capitellum fracture, must be repaired or reconstructed. Key words: Elbow joint; Radius fractures; Joint instability

The comparison of open reduction-internal fixation and resection arthroplasty techniques in the treatment of Mason type III radial head fractures

The comparison of open reduction-internal fixation and resection arthroplasty techniques in the treatment of Mason type III radial head fractures

Monteggia-like lesions - treatment strategies and one-year results.

Introduction: The eponym “Monteggia fracture” includes various patterns of complex fracture-dislocations of the proximal ulna and radius, which are not well defined yet. They are frequently described as Monteggia-like lesions or Monteggia equivalent injuries. Until today, these injury patterns have been reported rarely. The objective of this retrospective study was to better define patterns of injury and to document the short-term results of treatment with current fixation techniques.Methods: Ten patients with a Monteggia-like lesion were included in this study and clinical and radiological follow-up examinations at an average of 12.3 months after the trauma were performed. For clinical follow-up the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH score were utilized.Results: Osteosynthesis of the ulna was performed using a proximally contoured or precontoured LCP (locking compression plate) in all patients. All patients had a fracture of the radial head. All patients with a Mason type III radial head fracture received a cemented bipolar radial head prosthesis. All Mason type II fractures were treated with open reduction and internal fixation using mini screws. In all Mason type I fractures the treatment of the radial head dislocation was by closed reduction. Associated coronoid fractures were stabilized with lag screws through the ulnar plate or with independent lag screws after reduction of the fracture. According to the aforementioned scoring systems good to excellent results could be achieved.Conclusions: Our findings demonstrate that good or excellent short-term results can be obtained if the injury is classified correctly and a standardized surgical treatment of all components of the injury is achieved. Further studies with larger patient populations and longer follow up periods are needed to evaluate long-term effectiveness of this treatment concept.

One-year results of cemented bipolar radial head prostheses for comminuted radial head fractures.

Introduction: Comminuted radial head fractures (Mason type III) continue to pose a challenge to orthopedic surgeons. When internal fixation is not possible, radial head arthroplasty has been advocated as the treatment of choice. The purpose of this retrospective study was to evaluate clinical and radiological short-term results of patients with Mason type III radial head fractures treated with a cemented bipolar radial prosthesis.Methods: Twelve patients received cemented bipolar radial head hemiarthroplasty for comminuted radial head fractures. In all patients a CT scan was obtained prior to surgical treatment to assess all associated injuries. Postoperatively an early motion protocol was applied. All patients were evaluated clinically and radiologically at an average of 12.7 months.Results: According to the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH Score good to excellent results were obtained. Grip strength and range of motion were almost at the level of the unaffected contralateral side. Patient satisfaction was high, no instability or signs of loosening of the implant, and only mild signs of osteoarthritis were seen.Conclusion: Overall good to excellent short-term results for primary arthroplasty for comminuted radial head fractures were observed. These encouraging results warrant the conduction of further studies with long-term follow-up and more cases to see if these short-term results can be maintained over time.

Mason Type I Fractures of the Radial Head.

Mason type I fractures are the most common fractures of the radial head. The fractures have a benign character and often result in good, pain-free function. Nevertheless, up to 20% of patients with a Mason type I fracture report loss of extension and residual pain. Currently, there is a lack of consensus concerning diagnosis and treatment of these fractures. The goal of this study was to systematically review incidence, diagnosis, classification, treatment, and outcome of Mason type I radial head fractures in adults and establish an evidence-based treatment guideline. A search of the MEDLINE, EMBASE, and Cochrane databases was conducted for English titles without restrictions on publication date. The authors included titles that addressed Mason type I radial head fractures and covered incidence, diagnostics, treatment, or functional or patient-related outcome. Included were randomized controlled trials; case-control studies; comparative cohort studies; case series with more than 10 patients; and expert opinions. Reference lists were cross-checked for additional titles. The search yielded 1734 studies, of which 95 met the inclusion criteria. Seven studies showed that the elbow extension test has a high sensitivity (88.0-97.6) to rule out Mason type I radial head fractures. If radiography is required, antero-posterior and lateral radiographs suffice. For pain relief, hematoma aspiration seems safe and effective. Mason type I fractures are best treated with 48 hours of rest with a sling, followed with active mobilization. Cast immobilization should be avoided. Mobilization should be encouraged and if needed supported by physical therapy.

On-table reconstruction and fixation of Mason type III radial head fractures

PurposeTo evaluate the functional and radiological outcome of comminuted radial head fractures, which were not amenable for classical open reduction with internal fixation, treated by on-table reconstruction and fixation using low profile plates. MethodsWe reviewed 6 patients of Mason type III radial head fractures treated by on-table reconstruction technique between 2011 and 2013. There were 5 men and 1 woman with a mean age of 35 years (range 25–46 years). All surgeries were carried out at our tertiary care level 1 trauma centre within a mean of 3 days (range 1–8 days) from date of injury using on-table reconstruction technique. The functional outcome was measured using elbow functional rating index described by Broberg and Morrey and the patient-based Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. ResultsThe mean follow-up period was 25 months. The average elbow flexion was 135° (range 125°–140°) and the average flexion contracture was 5° (range 0–10°). The average supination and pronation was 75° (range 70°–80°) and 70° (range 65°–82°) respectively. According to Broberg and Morrey scoring system, the average score was 90 points (range 75–100). The mean DASH score was 2.49 points. ConclusionOn-table reconstruction and fixation of comminuted radial head fractures using low profile plates is a reasonable option. The reconstructed radial head acts as spacer and provides reasonably good results and no surgical intervention is required for asymptomatic nonunion of these fractures regardless of the radiological findings.

Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection?

To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old. We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH--Disabilities of the Arm, Shoulder and Hand; MEPS--Mayo Elbow Performance Score, VAS--Visual Analog Scale) and plain films. The mean follow-up was 40 months (range 24-72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3-45.8) and mean MEPS was 79 (range 65-97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability. Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples. Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.

Cross-screws fixation for radial neck fractures

Objective To evaluate the cross-screws fixation for displaced radial neck fractures. Methods A total of 29 patients with displaced radial neck fracture (Mason type Ⅱb) were treated by open reduction and cross-screws fixation at our department from October 2009 to August 2012. They were 18 males and 11 females, aged from 18 to 56 years (average, 37.2 years). The fractures affected 16 left and 13 right sides. The time from injury to operation was from 3 to 72 hours, with an average of 33.9 hours. All fractures were displaced by more than 2 mm or angulated by more than 30°, and caused by simple falling. The elbow function was evaluated by the Broberg & Morrey scoring system at one year postoperation. Results All the 29 patients were followed up for an average of 16 months (range, from 12 to 29 months). All fractures healed within 3 months, ranging from 4 to 12 weeks (mean, 10.6 weeks). By the Broberg & Morrey scores at one year postoperation, 15 patients were rated as excellent, 10 as good, 3 as fair and one as poor, giving an excellent to good rate of 86.2% . No wound infection, neural injury, fracture displacement or fixation failure occurred. No implants were removed due to local uneasiness. Conclusion Cross-screws fixation can achieve satisfactory outcomes for radial neck fractures. Key words: Radius; Elbow ioint; Fracture fixation, internal; Bone nails

Chondral Lesion of Capitellum Humeri Accompanying Radial Head Fracture: A Case Report

In this case report we present a case of full thickness chondral lesion of anterior-distal surface of capitellum humeri, accompanying an intra-articular radial head fracture. Importance of this case is the resemblance of chondral injury to Lorenz-Kocher lesion of humerus and atypical displacement of chondral fragments. A 32-year-old male, admitted to emergency room after fall on his right upper extremity. X-ray and CT scan of elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered. After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was pain-free with full participation in activities of daily living with a DASH score of 12,5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible from unexplainable and unfavorable outcome following low energy radial head fractures, treated conservatively.

Simultaneous bilateral Mason type IIb radial head fractures in a young female: Was an increased carrying angle the cause?

Radial head fracture is the most common type of elbow fracture in adults. It results from a fall on an outstretched hand. However, simultaneous bilateral radial head fractures are extremely rare. We report a case of simultaneous bilateral mason type IIb radial head fractures in a young female, which was treated nonoperatively with excellent results.

The Effect of Capitellar Impaction Fractures on Radiocapitellar Stability

To determine the effect of capitellar impaction fractures on radiocapitellar stability in a model that simulated a terrible triad injury. Six cadaveric elbows were dissected free of skin and muscles. Tendons were preserved. The lateral collateral ligament was released and repaired (surgical control). Two sizes of capitellar impaction defects were created. After lateral collateral ligament release and repair, we then sequentially created osseous components of a terrible triad injury (partial radial head resection and coronoid fracture) through an olecranon osteotomy that was fixed with a plate. Radiocapitellar stability was recorded after the creation of each new condition. Significantly less force was required for radiocapitellar subluxation after the creation of 20° and 40° capitellar defects compared with the surgical control (intact capitellum). After the addition of a Mason type II radial head defect and then a coronoid defect, stability decreased significantly further. Impaction fractures of the distal portion of the capitellum may contribute to a loss of radiocapitellar stability, particularly in an elbow fracture-dislocation. Because these injuries may be unrecognized, consideration should be given to diagnosing and addressing them.