[Reconstruction of the medial collateral ligament of elbow]

To evaluate the clinical effect of excising the radial head, repairing or reconstructing the medial collateral ligament (MCL) in treating comminuted fracture of the radial head accompanying by MCL injury.

From September 2000 to April 2006, 18 patients with comminuted fractures of radial head accompanying by MCL injury were treated by excision of the radial head, repair or reconstruction of the MCL. Of them, there were 12 males and 6 females, aged 21 to 57 years. Injury was caused by high falling in 10 cases and by traffic accidents in 8 cases. According to Mason classifications, 13 fractures were of type III and 5 of type IV. Fifteen cases of fresh fractures were operated within 2 weeks, 3 cases of old fractures at 4, 6, and 14 months after injury respectively. Four cases underwent MCL repair and 14 cases underwent MCL reconstruction.

All the 18 cases were followed up 1-5 years (mean 3 years). According to Broberg and Morrey scoring system, 4 patients were rated as excellent, 12 as good, 1 as fair, and 1 as poor. The excellent and good rate was 88.9%. Three patients had light pain of elbow, 1 patient had moderate pain and the other 14 had no pain. The range of elbow motion was from 110 to 140 degrees (mean 130 degrees). The pronation averaged 75 degrees (35-85 degrees). The supination averaged 80 degrees (65-89 degrees). Compared with normal limbs, the grip strength decreased by 3% to 28% (mean 15%); the extension strength decreased by 8% to 39% (mean 30%); the flexion strength decreased by 7% to 29% (mean 18%); the pronation strength decreased by 7% to 31% (mean 20%); the supination strength decreased by 15% to 45% (mean 25%). The X-ray films showed that carrying angle increased by 0 to 11 degrees (mean 5 degrees) under two-newton-meter valgus torque. There were significant differences between injured limbs and normal limbs (P < 0.05).

The MCL was the primary valgus stabilizer of the elbow. If the radial head replacement could not be carried out, the repair or reconstruction of the medial collateral ligament was effective.