الفهرس 
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Abstract
This study was conducted in the department of Orthopedics, Sohag university hospital, Sohag University during the period between January 2014and June 2014.
Twenty patients of fracture head radius managed operatively by internal fixation with plate, screw, K-wire during the course of the study were sorted and each was followed for at least 6 months.
Follow up of all patients were carried out regularly with clinical and radiological assessment till 6 months postoperatively.
The aim was to compare the results of the use of plate ,screw ,K-wire at fixation of head radius fracture All the patients were examined clinically and radiological, including detail history of premorbid status at the time of admission. Patients fulfilling the inclusion criteria was only included in the study.
Mean age in years for male=36.13 year, Mean age in years for female= 32.6 year Mean age in years both groups combined = 35.25 year
There was a male preponderance in our patients. A male to female ratio in all patients was about 3:1.
Most Head radius fracture has been occur in 13 patient at right side (65%) and 7 patient at left side(35%).
Common mode of injury a fall on our stretched hand.
Majority of patients in present study series were operated within 5 days following admission in hospital (15/20) (3patient were Masons’ type 4 and 12 patient were Masons’ type 2). But in some patients (5/20) operative procedure was delayed due to medical problems (Hypertension, diabetes and ischemic heart disease) and financial constraints of patients. Amongst patients who had a delay in operative intervention, three patients came to hospital following 10 days of trauma (3patient were Masons’ type 2 and 2 patient were Masons’ type 4).
Associated injuries have been found in Masons’ type 4 with (elbow dislocation - ligament injury - coronoid fracture or Monteggia lesion).but in Masons’ type 2 one cases have associated fracture tibia . 2cases fracture ulna In type 2 one case has associated neurological cardiothoracic problems but in type 4 three cases have associated neurological or cardiothoracic problems.
Average time of union in all our 20patients was about 10 weeks (Range: 8 to 12 weeks) There is some controversy regarding criteria for time of fracture union in different studies. Some use radiological while some use radiological and clinical union.
The range of motion, pain, the return to the work are better at type 2 than type 4.
Treatment of radial head fractures represents a real technical challenge facing the orthopedic surgeons. The goals of treatment are to restore elbow stability, preserve elbow motion, and maintain the relative length of the radius.
In the majority of fractures that are undisplaced these aims are accomplished with a few days of immobilization followed by prompt resumption of elbow motion. When large bony fragments block motion or are displaced markedly most surgeons will attempt open reduction and internal fixation because technology today allows for low-profile stable fixation, which permits early elbow rehabilitation.
When faced with the more complicated comminuted fracture pattern, one enters a gray area in which clinical decision making depends on factors unique to each patient. The approach in these cases consists of either conservative management, open reduction and internal fixation (ORIF), excision of the radial head, or radial head arthroplasty. Treating complex radial head fractures with ORIF can yield good results in the hands of experienced surgeons who are well versed in this procedure. This can require a longer surgical time relative to other procedures, however, because fixation can be demanding technically and may require future removal of hardware. Historically excision of the radial head was the surgical solution for complex radial head fractures. It has become less popular as concerns about delayed sequelae emerged. These include wrist pain, valgus instability of the elbow, loss of strength, and ulnohumeral arthritis. At the same time the instrumentation for internal fixation and arthroplasty has improved. Masons’ type 2 has better result than Masons’ type 4.
CONCLUSION
In this study which was carried out in Sohag University Hospitals, faculty of medicine, Sohag University from January2014to June 2014.
Twenty patients with fracture head radius (15 type2 and 5 type 4) were included. They were treated by plate, screw or K-wire.
In this study we aimed to evaluate the functional outcomes after open reduction and internal fixation of fracture head radius in adult type II-IV according to Mason, s classification
1. As soon as the patient with suspected head radius fracture was seen, necessary clinical and radiological evaluation done and admitted to the ward after necessary resuscitation and above elbow slab was done
2. Treatment of radial head fractures represents a real technical challenge facing the orthopaedic surgeons
3. The goals of treatment are to restore elbow stability, preserve elbow motion, and maintain the relative length of the radius.
4. Historically excision of the radial head was the surgical solution for complex radial head fractures. It has become less popular as concerns about delayed sequelae emerged. These include wrist pain, valgus instability of the elbow, loss of strength, and ulnohumeral arthritis.
5 The results were classified according to Weseley et al (1983) A comparison of these results with that of patients’ own rating of the outcome was made.
6. In this study, we found that the result of type 2 fixation are better than type 4.
7.At type 2 earlier return to the work less pain and less complication than type 4 .
8. Early motion is very important to avoid stiffness of the elbow.
9.Masons’ type II fractures of the radial head are the most controversial, as regards management. In displaced fractures, there is disagreement over the indications for Conservative and operative treatment
10. Masons’ type 4 is a complex injury that involves soft tissues, articular cartilage and bone. This combined lesion has been reported to have a worse prognosis than of the single injuries
11. In the present study, we do fixation by plate, K-wire and screw .We found that the result is better by K-wire and screw than plate.