To The Editor:
I read the article by Åkesson et al.(1) regarding
Brobery Mason Type IIa injuries. I noted that 6 of 49 patients had
unsatisfactory outcomes; all of these had delayed excision of
their Radial Heads.
I was unable to find any reference to either presence or absence of
Essex-Lopresti Injury in this cohort or the 6 patients with poor outcome.
Was it not present at all, or was it not looked for at the time of the original
injury?
It would be helpful to know if the authors still recommend
'Non-Operative' treatment in Mason Type IIa fractures with Essex-Lopresti
Injury, as this may be an entirely different beast.
I suggest that there is a need for modification of the Broberg
Modification of the Mason Classification with presence of Essex-Lopressti
Injury. In order to make comparision of similar injuries/fracture patterns
and their outcomes, it may be helpful to classify those with associated
Essex-Lopresti with Type II & Type III to be classed as IIc & IIIc
respectively.
This would not only make management planning easier but would result
in properly matched pairs in outcome studies.
The author(s) of this letter to the editor did not receive payment or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author(s) are affiliated or associated.
Reference:
1. Thomas Akesson, Pär Herbertsson, Per-Olof Josefsson, Ralph
Hasserius, Jack Besjakov, and Magnus K. Karlsson.
Primary nonoperative treatment of moderately displaced two-part fractures
of the radial head.
J Bone Joint Surg Am 2006; 88: 1909-1914
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