Analysis of misdiagnosis in the diagnosis and treatment of capitulum cartilage injury fragments interposed into the gap of the radial head fractures
Objective To investigate the clinical characteristics and misconceptions in the diagnosis and treatment of capitulum cartilage injury(CCI)fragments interposed into the gap of the radial head fractures(RHFs).Methods A retrospective study was conducted on 9 patients with concomitant CCI fragments interposed into the gap of the RHFs,which were confirmed by intraoperative exploration from January 2011 to December 2022.There were 6 males and 3 females.The age ranged from 17 to 69 years old,with an average of 36.1 years.The clinical characteristics were analyzed.RHF was classified according to Mason's classification and CCI was classified according to Wang Jian's method.The follow-up time ranged from 13 to 30 months,with an average follow-up of 14.2 months.The function of the affected limb was evaluated by Mayo Elbow Score(MEPS).Results This fracture accounted for 6.8％of RHF,and accounted for 25％of RHS with CCI.6 cases caused by falls and 3 cases by falls from height.All had significantly limited range of movement(ROM)of flexion-extension and rotation of the forearm,and 4 cases had local crepitus.6 cases underwent surgery because of severe RHS and 3 cases because of positive physical examination test after local anesthesia with light RHF.RHF included 1 case of Mason type I,7 type Ⅱ and 1 type Ⅲ.CCI included 3 cases of type I,4 type Ⅱ and 2 type Ⅲ.CCI was diagnosed by preoperative MRI in 1 case with type Ⅲ,and the remaining 8 cases were negative by radiology examinations.CCI was located on the lateral side of the humeral head in 4 cases,posterolateral in 3 cases,and anterolateral in 2 cases,its size ranged from 12 mm2 to 100 mm2,with an average of 19.8 mm2.All RHFs were internally fixed.CCI was removed in 8 cases,sutured in 1 case,and microfracture performed for type Ⅱ in 2 cases.All fractures healed.At the last follow-up,the excellent and good rate was 88.9％according to MEPS.Conclusions CCI fragments interposed into the gap of RHFs is rare and easy to be missed,but obviously limited ROM,local crepitus and a positive physical examination after local anesthesia suggest possibility of this fracture.Surgical exploration remains the gold standard for diagnosis and deserves attention.CCI should choose different treatment methods according to its type.
Radial head fractureConcomitant injuryCapitulum cartilage injuryPhysical examination after local anesthesiaIntraoperative exploration
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