1
|
Teilmann JF, Petersen ET, Thillemann TM, Hemmingsen CK, Kipp JO, Stilling M. Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis. J Exp Orthop 2024; 11:e12092. [PMID: 39119048 PMCID: PMC11306918 DOI: 10.1002/jeo2.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose Radial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA). Methods Eight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated- and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, -2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step-cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems. Results Compared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position. Conclusions The anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size. Level of Evidence Level III.
Collapse
Affiliation(s)
- Johanne F. Teilmann
- AutoRSA Research Group, Orthopedic Research UnitAarhus University HospitalAarhusDenmark
| | - Emil T. Petersen
- AutoRSA Research Group, Orthopedic Research UnitAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Orthopedic SurgeryAarhus University HospitalAarhusDenmark
| | - Theis M. Thillemann
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Orthopedic SurgeryAarhus University HospitalAarhusDenmark
| | | | - Josephine O. Kipp
- AutoRSA Research Group, Orthopedic Research UnitAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopedic Research UnitAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Orthopedic SurgeryAarhus University HospitalAarhusDenmark
| |
Collapse
|
2
|
Modarresi S, MacDermid JC, Walton DM, King GJW. Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years. J Hand Surg Am 2024; 49:710.e1-710.e8. [PMID: 36566104 DOI: 10.1016/j.jhsa.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/18/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. METHODS The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. RESULTS Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. CONCLUSIONS In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Shirin Modarresi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada; Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - David M Walton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Graham J W King
- Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| |
Collapse
|
3
|
Le Mapihan M, Amsallem L, Ing D, Masméjean EH. Midterm outcomes of a short-cemented bipolar radial head arthroplasty, in a cohort of 56 cases with minimum 2-years follow-up. Orthop Traumatol Surg Res 2024; 110:103716. [PMID: 37865236 DOI: 10.1016/j.otsr.2023.103716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 10/23/2023]
Abstract
BACKGROUND Radial head prostheses are used in comminuted radial head fractures for elbow stabilisation when reduction and internal fixation is not possible. Several implant designs exist, but no large series exist about a short-cemented and bipolar implant. HYPOTHESIS The hypothesis was that this prosthesis design shows good clinical, functional, and radiological results, with acceptable rate of complications. STUDY DESIGN This retrospective study included the prostheses with bipolar design and short-cemented stem (Evolutive™), with a minimum 2-years follow-up. MATERIALS AND METHODS All prosthesis implanted in our Traumatology Center were included, with minimum 2-years follow-up. The evaluation consisted of a clinical and functional evaluation, associated with an independent radiographic assessment. All complications were listed, as long as rate and reasons for implant removal. RESULTS Fifty-six implants were studied with a mean follow-up of 64.9months (24 to 119). Fifty-three cases were acute injuries with 16% isolated radial head fractures and 76% complex elbow injury such as ulno-humeral, radio-ulnar or longitudinal forearm instability. Fifty (89%) implants were still in place at last follow-up. The main reason for implant removal was during arthrolysis procedure. Ranges of motion were: 126° in flexion, 9° of extension loss, 76° of pronation and 79° of supination. Mean Mayo Elbow Performance Index was 84.1 with 72% of excellent or good results, and the median quick-DASH was rated 18.2. Radiographic evaluation found 12% significant ulno-humeral arthtitis, 64% capitellar osteopenia and 12% loosening. We recorded 5% of implant-related complications. DISCUSSION The short-cemented stem bipolar radial head prosthesis presents clinical and functional results similar to other radial head prosthesis with low incidence of elbow arthritis, when treating both isolated radial head fracture or complexes elbow injury. This implant should therefore be valid for treating comminuted radial head fractures in all types of traumatological injuries. LEVEL OF EVIDENCE IV; Retrospective cohort study.
Collapse
Affiliation(s)
- Marie Le Mapihan
- Hand, upper limb and peripheral nerve surgery service, Georges-Pompidou European Hospital (HEGP), Paris, France; Université de Paris Cité, Paris, France.
| | - Lior Amsallem
- Hand, upper limb and peripheral nerve surgery service, Georges-Pompidou European Hospital (HEGP), Paris, France; IECEM - Polyclinique Saint-Côme, Compiègne, France
| | - David Ing
- General radiology service, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emmanuel H Masméjean
- Université de Paris Cité, Paris, France; Clinique Sainte Genevieve Groupe Pauchet, 75014 Paris, France.
| |
Collapse
|
4
|
Shimura H, Wakabayashi Y, Yamada T, Shirakawa K, Sato T, Fujita K, Niizeki Y, Suzuki S, Kaburagi H, Suzuki H, Nimura A. Radiographic and clinical comparisons between loose-fit and press-fit stems in monopolar radial head arthroplasty for comminuted radial head fractures. J Orthop Sci 2024:S0949-2658(24)00014-9. [PMID: 38342710 DOI: 10.1016/j.jos.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/16/2023] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE Few clinical studies have compared the operative outcomes between loose- and press-fit stems in radial head arthroplasty (RHA). We aimed to evaluate the radiographic and clinical results of the two radial head implant concepts. METHODS In this retrospective multicenter study, 32 patients (24 women and 8 men) with a mean age of 63.1 years who underwent RHA for comminuted radial head fractures were reviewed between 2005 and 2021. Seventeen patients underwent RHA with a loose-fit stem (L-group), whereas the remaining fifteen patients underwent RHA with a press-fit stem (P-group). The mean follow-up period was 40.1 ± 9.9 months, with the minimum follow-up duration of 12 months. The radiographic findings were evaluated for periprosthetic osteolysis; furthermore, clinical outcomes were analyzed to measure the range of motion of the elbow. The rate of reoperations and prosthesis removal were also reviewed. RESULTS The general characteristics of the patients were similar in the two groups. The rate of periprosthetic osteolysis was 17.6% in the L-group, whereas it was 53.3% in the P-group. The mean elbow flexions were 128° and 133° in the L- and P-groups, respectively. The mean elbow extensions were -12° and -9° in the L- and P-groups, respectively. The rate of reoperation was 23.5% in the L-group and 15.2% in the P-group. One patient in the L-group had the prosthesis removed because of surgical site infection, whereas one patient in the P-group had the prosthesis removed owing to painful loosening. CONCLUSIONS No significant differences in the clinical outcomes and reoperation rate were observed between the two radial head implant concepts in this study. However, osteolysis occurred more frequently in the P-group. Although patients with periprosthetic osteolysis are currently asymptomatic, they should be carefully followed up for the symptoms in the long term.
Collapse
Affiliation(s)
- Haruhiko Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center. 3-4-32 Todaijima, Urayasu-City, Chiba, 279-0001, Japan.
| | - Yoshiaki Wakabayashi
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuya Yamada
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ken Shirakawa
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuya Sato
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yumi Niizeki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shiro Suzuki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hidetsugu Suzuki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| |
Collapse
|
5
|
Helmstetter T, Maniglio M, Fornaciari P, Tannast M, Vial P. Open reduction and internal fixation of modified Mason type III/IV radial head fractures with more than three fragments: an analysis of the clinical outcome and reoperation rate. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1121-1130. [PMID: 37962633 PMCID: PMC10858131 DOI: 10.1007/s00590-023-03772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE It is generally accepted that a radial head fracture (RHF) with more than three parts is not suitable for repair; therefore, most authors suggest straightforward radial head arthroplasty (RHA). With up to 20% risk for reoperation after RHA, improvement in reduction and fixation techniques may represent a valuable alternative before further extending the indications for arthroplasty. To determine the functional results and radiological failure rate after osteosynthesis of multi-fragmentary RHF with more than three articular fragments. We specifically determined (1) the one-year Broberg and Morrey functional elbow score, (2) duration of fracture healing, (3) complication rate, and (4) number of patients converted to RHA. METHODS This study is a retrospective single-center case series. All patients who underwent primary osteosynthesis for RHF between 2012 and 2019 were included. Nine patients with an average age of 52 years had an average clinical and/or radiological follow-up of 49 months. RESULTS The preoperative imaging identified nine fractures with four fragments. Three patients underwent osteosynthesis with plates and screws, whereas six patients underwent osteosynthesis with only screws. The mean Broberg and Morrey score was 95 points. Overall, eight of the nine patients had satisfactory results. All patients retained their radial heads and showed radiological fracture healing. Only two patients presented with low-grade complications requiring no further surgery. CONCLUSION Our study showed that osteosynthesis of RHF with up to four fragments can achieve good functional results with a low complication rate and seems to be a valid alternative to RHA.
Collapse
Affiliation(s)
- Timothée Helmstetter
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland.
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland.
| | - Mauro Maniglio
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Paolo Fornaciari
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Moritz Tannast
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Philippe Vial
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| |
Collapse
|
6
|
Walsh A, Zhang Y, McGough J, Kim J, Hausman M. Open Reduction Internal Fixation of Simple Versus Comminuted Radial Head Fractures: Comparison of Clinical Outcomes. J Hand Surg Am 2023; 48:1059.e1-1059.e9. [PMID: 35545488 DOI: 10.1016/j.jhsa.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Current teaching suggests that modified Mason type III and IV fractures of the radial head involving more than 3 fragments should be treated with radial head arthroplasty. The purpose of this study was to compare the outcome of simple (2 or fewer intra-articular pieces) versus comminuted (3 or more intra-articular pieces) radial head fractures treated with open reduction internal fixation (ORIF). METHODS This was a retrospective review of 35 patients with modified Mason type III and IV fractures treated with ORIF. For the purpose of our study, simple fractures were defined as having 2 or fewer intra-articular fragments. Comminuted fractures were defined as having 3 or more intra-articular fragments. The primary outcomes were Broberg and Morrey rating system and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Reoperation rates and complications were also noted. RESULTS Thirty-five patients were evaluated, with a mean follow-up of 39.3 months. Thirteen patients had radial head fractures consisting of 2 or fewer intra-articular fragments. Twenty-two patients had radial head fractures consisting of 3 or more intra-articular fragments. Ages and follow-up times were similar in the 2 groups. Similar QuickDASH and Broberg and Morrey scores were seen when evaluating subgroups of 2, 3, and 4 fragment fractures. One patient from each group underwent revision surgery for symptomatic hardware. CONCLUSIONS In our series, we found similar clinical outcome scores and reoperation rates between simple and comminuted radial head fractures treated with ORIF. Fractures with more than 3 intra-articular fragments can be considered for ORIF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | | | | | - Jaehon Kim
- Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
7
|
Klug A, Jakobi T, Schnetz M, Hagebusch P, Gramlich Y, Hoffmann R. Mid-term outcome following radial head arthroplasty in acute trauma: risk factors for poor outcome. J Shoulder Elbow Surg 2023; 32:2140-2151. [PMID: 37327986 DOI: 10.1016/j.jse.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aims of this study were to evaluate the outcomes of a single type of radial head implant in a large cohort of patients at mid-term follow-up and to determine the associated risk factors for inferior functional outcomes. METHODS We performed a retrospective follow-up assessment of 65 patients (33 women and 32 men; mean age, 53.3 years [range, 22-81 years]) who underwent radial head arthroplasty (RHA) for acute trauma between 2012 and 2018, after a minimum follow-up period of 3 years. The Mayo Elbow Performance Score, Oxford Elbow Score, Disabilities of the Arm, Shoulder and Hand score, and Mayo Modified Wrist Score were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following RHA. RESULTS After an average follow-up period of 4.1 years (range, 3-9.4 years), the mean Mayo Elbow Performance Score was 77.2 (standard deviation [SD], 18.9); mean Oxford Elbow Score, 32.0 (SD, 10.6); mean Mayo Modified Wrist Score, 74.6 (SD, 13.7); and mean Disabilities of the Arm, Shoulder and Hand score, 29.0 (SD, 21.2). Average range of motion measured 10° (SD, 15°) in extension, 125° (SD, 14°) in flexion, 81° (SD, 14°) in pronation, and 63° (SD, 24°) in supination. The overall complication and reoperation rates were 38.5% and 30.8%, respectively, with severe elbow stiffness being the most common reason for revision. Patient age >50 years, the use of an external fixator, the presence of accompanying medial collateral ligament injuries, and the development of higher-grade osteoarthritis were associated with a poor outcome. CONCLUSION Satisfactory medium-term outcomes can be achieved using a monopolar, long-stemmed RHA in patients with acute trauma. However, complication and revision rates are high, frequently leading to inferior outcome scores. Additionally, a higher patient age, the use of an external fixator, the presence of accompanying medial collateral ligament injuries, and the occurrence of higher-grade osteoarthritis were associated with a poor outcome; these factors should raise awareness by the treating trauma surgeon.
Collapse
Affiliation(s)
- Alexander Klug
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Tim Jakobi
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias Schnetz
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
8
|
van Bussel EM, Lindenhovius AL, The B, Eygendaal D. Silicone radial head prostheses revisited: do they have a role in today's practice? A systematic review of literature on clinical outcomes. Clin Shoulder Elb 2023; 26:312-322. [PMID: 37088881 PMCID: PMC10497923 DOI: 10.5397/cise.2022.00990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Silicone radial head prostheses (SRHP) are considered obsolete due to reports of frequent failure and destructive silicone-induced synovitis. Considering the good outcomes of modern non-radial silicone joint implants, the extent of scientific evidence for this negative view is unclear. The aim of this research was to systematically analyze the clinical evidence on complications and outcomes of SRHP and how SRHP compare to both non-SRHP and silicone prostheses of other joints. METHODS A systematic literature review was conducted through the Cochrane, PubMed, and Embase databases. RESULTS Eight cohort studies were included, consisting of 142 patients and follow-up periods ranging from 23 months to 8 years. Average patient satisfaction was 86%, range of 71%-100%, and 58 complications were seen, but no cases of synovitis. These outcomes were in line with non-SRHP. Four case series with 11 cases of synovitis were found, all due to implant fractures years to decades after implantation. Six systematic reviews of currently used non-radial silicone joint implants showed excellent outcomes with low complication rates. CONCLUSIONS Since SRHP have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications, it is considered that SRHP can still be chosen as a potential surgical treatment method in current clinical practice.
Collapse
Affiliation(s)
- Erik M van Bussel
- Department of Orthopedic Surgery UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopedic Surgery, Erasmus University Hospital, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Campbell BR, Rengifo S, Wickes CB, Amer KM, Ilyas AM. Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-up of 8 Years. J Hand Surg Am 2023:S0363-5023(23)00253-8. [PMID: 37354192 DOI: 10.1016/j.jhsa.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. METHODS A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. RESULTS A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81-128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. CONCLUSIONS Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Benjamin R Campbell
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Santiago Rengifo
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Catherine B Wickes
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Kamil M Amer
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
10
|
Corbaz J, Barimani B, Vauclair F. Early aseptic loosening of a press-fit radial head prosthesis - A case series of 6 patients. J Int Med Res 2023; 51:3000605221135881. [PMID: 37082909 PMCID: PMC10126620 DOI: 10.1177/03000605221135881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Radial head arthroplasty (RHA) is the principal treatment option for comminuted radial head (RH) fractures. Here, we present six cases of failed RHA using a modular monopolar press-fit RHA that was subsequently withdrawn from the market because it was associated with a high incidence of loosening. METHODS We retrospectively collected data from six patients who had received Radial Head Prothesis SystemTM at our centre between July 2015 and June 2016. The average follow-up was 40 months. RESULTS Aseptic loosening of the stem affected five (83%) of the six RHA. Four of these were symptomatic and RHA removal was performed. For these patients, the pain subsided and their elbow range of motion (ROM) improved. CONCLUSION While the ideal design for an RHA is still debatable, RHA is an efficient treatment option that restores elbow stability and function after a comminuted RH fracture. Importantly, removal of the prosthesis is an effective remedy following RHA associated elbow pain and decreased ROM.
Collapse
Affiliation(s)
- J Corbaz
- Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - B Barimani
- Department of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - F Vauclair
- Bone and Motion Center - Hirslanden, 1006 Lausanne, Switzerland
| |
Collapse
|
11
|
Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology. J Shoulder Elbow Surg 2023; 32:463-474. [PMID: 36403925 DOI: 10.1016/j.jse.2022.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The radial head is the forearm's pivot point for supination-pronation. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. METHODS In this study, 23 patients who had comminuted radial head fractures had personalized radial head prostheses inserted. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. The mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow range of motion, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were evaluated 2 years postoperatively. RESULTS QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. DISCUSSION Since personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomies were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results.
Collapse
|
12
|
Barret H, Mansat P, Langlais T, Favard L, Chammas M, Coulet B. After failed radial head arthroplasty, what are the options? Risk factors and results of revisions in a multicenter study. J Clin Orthop Trauma 2023; 38:102128. [PMID: 36860992 PMCID: PMC9969247 DOI: 10.1016/j.jcot.2023.102128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/08/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Few multicenter studies have analyzed the outcome of revision surgery of radial head arthroplasties (RHA) in the medium term follow up. The objective is twofold: to determine the factors associated with revision of RHAs and to analyze the results of revision with 2 surgical techniques: isolated removal of the RHA or revision with a new RHA (R-RHA). Hypothesis There are associated factors of RHA revision and RHA revision results in satisfactory clinical and functional outcomes. Methods Twenty-eight patients were included in this multicenter retrospective study, with all surgical indications for initial RHA being traumatic/post-traumatic. The mean age was 47 ± 13 years with a mean follow-up of 70 ± 48 months. This series included two groups: the isolated RHA removal group (n = 17) and the revision RHA with new radial head prosthesis (R-RHA) group (n = 11). Evaluation was clinical and radiological with univariate and multivariate analysis. Results Two factors associated with RHA revision were identified: a pre-existing capitellar lesion (p = 0.047) and a RHA placed for a secondary indication (<0.001). Revision for all 28 patients resulted in improved pain (pre-op Visual Analog Scale 4.7 ± 3 vs. post-op 1.57 ± 2.2, p < 0.001), mobilities (pre-op flexion 118 ± 20 vs. post-op 130 ± 13, p = 0.03; pre-op extension -30 ± 21 vs post-op -20 ± 15, p = 0.025; pre-op pronation 59 ± 12 vs post-op 72 ± 17, p = 0.04; pre-op supination 48 ± 2 vs post-op 65 ± 22, p = 0.027) and functional scores. Mobility and pain control were, for stable elbows, satisfactory in the isolated removal group. When the initial or revision indication was instability, the DASH (Disabilities of the Arm, Shoulder and Hand = 10 ± 5) and MEPS (Mayo Elbow Performance score = 85 ± 16) scores were satisfactory in the R-RHA group. Discussion In the case of a radial head fracture, RHA is a satisfactory first-line solution without pre-existing capitellar injury, its results being much weaker in the case of ORIF failure and fracture sequelae. In case of RHA revision, isolated removal or R-RHA adapted according to the pre-operative radio-clinical exam. Level of evidence IV.
Collapse
Affiliation(s)
- Hugo Barret
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Mansat
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Tristan Langlais
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Michel Chammas
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| |
Collapse
|
13
|
Zhang D, Dyer GSM, Earp BE, Blazar P. Complications, Reoperations, and Long-Term Outcomes after Open Reduction Internal Fixation of Mason Classification Type II and Type III Radial Head Fractures. J Hand Microsurg 2023; 15:45-52. [PMID: 36761044 PMCID: PMC9904971 DOI: 10.1055/s-0041-1724223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The objectives of this study were to assess long-term outcomes, complications, and reoperations after open reduction internal fixation (ORIF) of radial head fractures. Materials and Methods 35 adult patients, who underwent ORIF of an isolated, displaced radial head fracture without elbow instability (Mason classification type II or III) at two tertiary care referral centers from 2000 to 2017, were identified. Patient satisfaction, pain, and QuickDASH scores were assessed by telephone follow-up at median 12.9 years. Results The mean age of the 35 patients in our study was 39 years, and 54% were women. The median length of clinical follow-up was 175 days. Postoperative complications occurred in 54% of patients, and reoperations in 23% of patients. Multivariable logistic regression identified fixation with plate and screws versus screws alone as a risk factor for complications and reoperations. The long-term telephone follow-up response rate was 54%. At 13-year median follow-up, the average patient satisfaction was 9.6/10, the average patient-reported pain was 0.7/10, and the average QuickDASH score was 10.5. Conclusion The long-term outcomes of ORIF of Mason classification type II and III radial head fractures are favorable; however, rates of complication and reoperation are notable and may be higher with plate-and-screw fixation.
Collapse
Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - George S. M. Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Brandon E. Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
14
|
Nieboer MJ, Austin DC, Uvodich ME, Rogers TH, Barlow JD, Sanchez-Sotelo J, O'Driscoll SW, Morrey ME. Acute versus delayed radial head arthroplasty for the treatment of radial head fractures. J Shoulder Elbow Surg 2022; 31:2506-2513. [PMID: 36115618 DOI: 10.1016/j.jse.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty (RHA) is an important tool in the acute treatment of comminuted radial head and neck fractures. RHA is also performed in a delayed manner after failed open reduction and internal fixation, for fracture malunion or nonunion, and other chronic post-traumatic elbow disorders where restoration of the lateral column of the elbow is considered necessary. The relative efficacy and longevity of acute vs. delayed RHA is unknown. We sought to compare clinical, radiographic, and patient-reported outcomes between these groups. METHODS We identified patients ≥18 years old who underwent an RHA between 2000 and 2018 and then extracted 135 total elbows with a mean follow-up of 2.3 years that sustained isolated radial head fractures (30%), terrible triad injuries (66%), or Essex-Lopresti injuries (4%). The acute cohort (RHA: <12 weeks) contained 101 elbows that underwent surgery at a mean of 0.6 weeks (range, 0 days to 7 weeks, 96% <2 weeks) from injury, whereas the delayed cohort (RHA: 12 weeks to 2 years) contained 34 elbows that underwent surgery at a mean of 36 weeks (range, 14-82 weeks) from injury. Patients in the acute group had a higher percentage of terrible triad injuries (75% vs. 40%, P < .001) and Mason 3 fractures (98% vs. 45%, P < .001). RESULTS At the final follow-up, 13 of 101 patients in the acute cohort (13%) and 7 of 34 patients in the delayed cohort (21%) required implant revision or resection. A total of 25 patients (25%) in the acute cohort and 12 patients (35%) in the delayed cohort required a reoperation. Kaplan-Meier 2-year survival estimates free of implant resection or revision (90% acute, 86% delayed) and reoperation (76% acute, 70% delayed) were similar between groups. In patients with 5-year follow-up, there was an increased rate of revision or resection in the delayed group (30% vs. 13%). Two-year survival estimates free of radiographic loosening were 80% in the acute cohort vs. 57% in the delayed cohort (P = .04). Mayo Elbow Performance Score at 2 years demonstrated mean scores of 83 and 79 in the acute and delayed groups, respectively, with 71% of the acute cohort and 64% of the delayed cohort achieving good or excellent scores. CONCLUSIONS Our results demonstrated that although 2-year Kaplan-Meier survival free of revision or resection estimates and reoperation rates was equivalent between the groups, the delayed group experienced worse Mayo Elbow Performance Score outcomes, a higher revision or resection rate at 5 years, and an increased rate of radiographic loosening.
Collapse
Affiliation(s)
- Micah J Nieboer
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Daniel C Austin
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Mason E Uvodich
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Thomas H Rogers
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
15
|
Yang G, Li S, Zhang H, Lu Y. A systematic review and meta-analysis on different stem fixation methods of radial head prostheses during long-term follow-up. Front Bioeng Biotechnol 2022; 10:1041531. [PMID: 36394008 PMCID: PMC9663814 DOI: 10.3389/fbioe.2022.1041531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/21/2022] [Indexed: 01/24/2023] Open
Abstract
Background: Radial head arthroplasty (RHA) is typically performed for non-reconstructible radial head fractures with or without valgus stability. The fixation methods can be divided into cemented rigid fixation, such as screw fixation, and uncemented micromovement fixation, including smooth stem, press-fit, expanded device, in-growth stem, and grit-blasted stem fixations. Different fixation methods may impact long-term clinical outcomes and cause complications. This study aimed to compare the long-term follow-up outcomes of cemented and uncemented radial head prostheses. Methods: A computerized literature search was performed in the PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases for studies on radial head prostheses, replacement, and arthroplasty published from inception to April 2022. The prostheses fixation method was divided into cemented and uncemented fixation groups. The outcomes of interest included the participant characteristics, prostheses types, clinical outcomes, reoperation rates, and complication rates during long-term follow-up. Results: A total of 57 studies involving 2050 patients who underwent RHA were included in our analysis. Cemented fixation was used in 23 of these studies, uncemented fixation in 35 studies, and both cemented and uncemented fixations in one study. Both fixation groups showed significantly improved clinical outcomes after treatment. In particular, both the reoperation and complication rates were lower in the uncemented fixation group (12% and 22%, respectively) than that in the cemented fixation group (20% and 29%, respectively). Among the studies, uncemented monopolar fixation had the lowest reoperation rate (14%), while cemented monopolar fixation had the highest reoperation rate (36%). Regarding complication rates, uncemented bipolar fixation yielded the lowest rate (12%), while cemented bipolar fixation yielded the highest rate (34%). The range of motion and clinical outcome scores were good in both groups. Conclusion: Uncemented radial head prostheses had lower reoperation and complication rates than cemented prostheses. In particular, uncemented monopolar prostheses may yield the lowest reoperation rate, while uncemented bipolar prostheses may yield the lowest overall complication rate.
Collapse
|
16
|
Viswanath AI, Watts AC. Survivorship of anatomic press-fit short-stem radial head replacement with a pyrocarbon bearing. Shoulder Elbow 2022; 14:426-433. [PMID: 35846394 PMCID: PMC9284301 DOI: 10.1177/17585732211024182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Restoring the radial head as a stabiliser of the elbow is considered important in cases where there is an associated bony or ligamentous injury. A variety of radial head prostheses are available. There are no reports of the survivorship of a short-stem press-fit radial head prostheses with pyrocarbon bearing. PATIENTS AND METHODS With institutional review board approval, a retrospective case-note analysis was performed of a consecutive single-surgeon case series of the Integra LifeScience pyrocarbon radial head prostheses (Carbon Modular Radial Head) from October 2010 to October 2019 in a tertiary referral centre. The series was divided into acute trauma and salvage cohorts. Kaplan-Meier survivorship analysis was conducted. RESULTS 36 patients were included, 23 (64%) for acute injuries and 13 (36%) for failed initial treatment. Of the acute injuries, 20 (87%) had a Wrightington type-C elbow fracture-dislocation. Reoperation was performed in 4 (11%) patients; 10 (28%) had possible loosening on radiographs. The implant survival rate was 94% at shortest follow-up of 17 months (mean 70 months). DISCUSSION Treatment of complex radial head fractures using a pyrocarbon-bearing, anatomic press-fit design provides satisfactory short-term survivorship in this case series. The implant should be used with caution in salvage cases, due to higher rates of loosening seen in this cohort.
Collapse
|
17
|
Nakahashi N, Iba K, Yamashita T. Anconeus interposition arthroplasty in an adolescent patient with osteogenesis imperfecta: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:427-430. [PMID: 37588873 PMCID: PMC10426648 DOI: 10.1016/j.xrrt.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naoya Nakahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
18
|
Shoji MM, Garcen MH, Fernandez Dell’Oca AA, Jupiter JB. Posteriorly Displaced Radial Head Fractures May Represent the Footprint of an Elbow Dislocation or Subluxation as a Variant of Modified Mason Type 4. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:501-506. [PMID: 35928906 PMCID: PMC9295585 DOI: 10.22038/abjs.2021.55486.2764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/06/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The purpose of this case series is to describe surgical decision making and clinical outcomes in posteriorly displaced radial head fractures with a major fragment (more than 50% of the head) located behind the humeral condyle. We also document the outcome of open reduction and internal fixation of completely displaced radial head fractures. METHODS A retrospective review of the ICUC® (Integrated Comprehensive Unchanged Complete) database was performed between 2012 and 2020. Patients were included if preoperative radiographs demonstrated a major radial head fracture fragment located posterior to the humeral condyle and a minimum of 2-year follow-up data was available. RESULTS Ten patients met inclusion criteria. Two patients had an associated elbow dislocation whereas 8 patients did not. All patients were found to have disruption of the lateral collateral ligament complex intraoperatively. Nine radial head fractures were successfully fixed with interfragmentary screws. One multi-fragmented radial head fracture could not be successfully stabilized with interfragmentary screw fixation and was resected. The average time to final follow-up was 4.8 years (range 2.2-8.1). At final follow-up, 6 patients demonstrated radiographic evidence of a healed radial head, 1 patient had avascular necrosis, and 2 had post-traumatic arthritis. None demonstrated radiographic instability. The average functional score was 0.64 (SD 0.81) and pain score was 0.45 (SD 0.93). The average elbow extension was 8 degrees (SD 11), elbow flexion was 139 degrees (SD 6), forearm supination was 60 degrees (SD 27), and forearm pronation was 69 degrees (SD 3). CONCLUSION Recognition of a posteriorly displaced radial head fracture is essential, as it may be an indirect sign of elbow instability. This instability should be addressed during surgical intervention.
Collapse
Affiliation(s)
- Monica M. Shoji
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | | | | | - Jesse B. Jupiter
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Clinical long-term results of radial head arthroplasty in comminuted radial head fractures. Musculoskelet Surg 2022; 107:197-206. [PMID: 35353327 DOI: 10.1007/s12306-022-00742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
Modern radial head prostheses have recently become more common in the treatment of comminuted radial head fractures. The goal of this study was to evaluate how well the EVOLVE® modular metallic radial head implant prosthetic restores the functional range of motion and stability of the elbow. 30 patients with comminuted radial head fractures received an arthroplasty with an EVOLVE® prosthesis in our institution. 20 of those patients were available for long-term follow-up (mean > 10 years). The outcomes were assessed on the basis of pain, motion, and strength. The overall outcome was scored with functional rating scores. According to the Broberg-Morrey elbow evaluation score, after a mean follow-up period of 10.2 years, ten (50.0%) patients were rated as very good, four (20.0%) as good, six (30.0%) as satisfactory, and none as poor. In the long-term results the Broberg-Morrey score increased from 79 (in short-term results) to 89 points. The Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure questionnaire showed an average of 16.2 points. Initially, patients had an extension deficit of 20°, which was reduced to 5° at the latest follow-up. In our long-term results, an improvement in the function of the elbow was observed after arthroplasty using a metallic modular radial head implant. Comminuted radial head fractures with elbow instability can be treated effectively with the EVOLVE® radial head prosthesis, which restores stability in acute treatment. Our long-term results after 10.2 years demonstrate good functional outcome and low major complication rate. IV.
Collapse
|
20
|
O’Connor CM, Kortlever J, Vagner GA, Reichel LM, Ring D. Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture. Hand (N Y) 2022; 17:308-312. [PMID: 32432481 PMCID: PMC8984733 DOI: 10.1177/1558944720918358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The decision between radial head arthroplasty and open reduction internal fixation in the context of a terrible triad elbow fracture-dislocation is debated. This study investigated both surgeon and patient factors associated with surgeons' recommendations to use arthroplasty. Methods: One hundred fifty-two surgeon members of the Science of Variation Group participated. Surgeons were asked to complete an online survey that included surgeon demographics and 16 patient scenarios. The patient scenarios were randomized using 2 patient variables and 2 anatomical variables. Multilevel logistic mixed regression analysis was performed to identify surgeon and patient variables associated with recommendations for radial head arthroplasty. Results: We found that radial head replacement was recommended in 38% of the scenarios. Scenarios with older patients, with fractures of the whole head, and those involving 3 fracture fragments were independently associated with radial head replacement. Conclusion: We found that most surgeons recommended radial head fracture fixation rather than arthroplasty. Surgeons were more likely to recommend fixation for younger patients with partial articular fractures or with fractures with 3 or fewer fracture fragments. It seems that surgeons are uneasy about using a prosthesis in a young active patient.
Collapse
Affiliation(s)
- Casey M. O’Connor
- Albany Medical Center, NY, USA,The University of Texas at Austin,
USA
| | | | | | - Lee M. Reichel
- The University of Texas at Austin,
USA,Lee M. Reichel, Dell Medical School, The
University of Texas at Austin, 1912 Speedway, Austin, TX 78712, USA.
| | | |
Collapse
|
21
|
Rafla S, Carroll EA, Wiesler ER, Li Z, Tuohy CJ, Nunez F, Graves BR, Papadonikolakis A. Early to midterm radiographic loosening of the press fit radial head prosthesis. Injury 2021; 52:3605-3610. [PMID: 33775415 DOI: 10.1016/j.injury.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radiographic loosening is frequently seen around the radial head (RH) implant. The hypothesis of this study was that radiographic loosening will be more frequent in patients in which the RH prosthesis was implanted due to elbow trauma leading to instability that required lateral collateral ligament repair (LCL). MATERIALS AND METHODS A retrospective review of the patients who had RH implantation between 2012 and 2019 was performed. Evaluation included evidence of radiographic loosening, stress shielding, formation of heterotopic ossification, and rate of removal of the implant. Range of motion of the elbow at the latest follow up was also recorded. RESULTS At a mean follow up of 18 months (range 1.4 - 80) eight out of 25 patients had radiographic loosening around the implant. The radial head implant was removed in 8 patients (in 3 due to painful radiographic loosening, in 4 due pain without radiographic loosening and in 1 due to infection). Radiographic loosening around the RH implant had no association with LCL repair (p=0.18) or future removal of implant (p=0.18) or the diagnosis of Monteggia lesion (p=0.68). In addition, removal of the RH implant had no association with prior LCL repair (p=0.60) or the diagnosis of Monteggia lesion (p=0.15). Stress shielding was seen in 5 patients and was of no clinical significance. Heterotopic ossification was seen in 12 patients and was classified as Class I in 3, IIA in 3, IIC in 6, according to the Hastings Classification. The average flexion-extension arc was 23° to 130°, and average pronation-supination was 76° to 69°. CONCLUSION One third of the patients had radiographic loosening around the RH implant at a mean follow up of 18 months. Pain with or without radiographic loosening were the main reasons for removal of the implant. No associations were found between the development of radiographic loosening and LCL repair at the time of RH replacement. Limitations of this study are: (a) the retrospective design (b). the small sample size and the possibility of a type II statistical error.
Collapse
Affiliation(s)
- Samuel Rafla
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Eben A Carroll
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Ethan R Wiesler
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Zhongyu Li
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Fiesky Nunez
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Benjamin R Graves
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | | |
Collapse
|
22
|
Page RS, Paltoglou NG, Arora V, Eng K, Gill SD. Retrospective review of pyrocarbon radial head replacement. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:376-380. [PMID: 37588705 PMCID: PMC10426669 DOI: 10.1016/j.xrrt.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Radial head arthroplasty is the preferred surgical management for complex, unreconstructable radial head fractures. There has been increasing use of pyrocarbon prostheses, with potential tribology and modulus advantages over metallic counterparts. This study aims to assess clinical and radiological outcomes for radial head replacement after trauma using a modular, uncemented pyrocarbon prosthesis. Materials and Methods Between September 2009 and March 2020, a consecutive series of 22 trauma cases were available for review. Patients underwent radial head arthroplasty using a pyrocarbon prosthesis (Ascension Modular Radial Head System, Austin, TX). Recorded outcomes included clinical assessment, radiological evaluation, and patient-reported outcome measures specific to elbow function. Results Twenty-two patients (7 male, 15 female) with an average age of 51 years (range 21-64) were analyzed with a minimum 12 months of follow-up. All patients had complex radial head fractures, categorized as a Mason 3 or 4 injury. At follow-up, mean elbow range of motion included flexion 130° (range 100°-150°), extension 19° (0-50°), pronation 73° (30°-90°), and supination 70° (10°-90°). The mean Mayo Elbow Performance Index score was 83 (55-100), and Disabilities of the Arm, Shoulder and Hand score was 22 (2.5-60). Radiological evaluation showed 14 patients with asymptomatic proximal neck resorption and two patients with radiological stem loosening. In total, 3 of 22 implants were revised-2 were excised, and 1 revised to a long stem for traumatic implant fracture. Conclusion Pyrocarbon radial head arthroplasty provided reliable functional results for patients after unreconstructable radial head fracture. The unique potential for fracture of the prosthesis should be considered in long-term follow-up, with appropriate activity advice to patients.
Collapse
Affiliation(s)
- Richard S. Page
- Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia
- St. John of God Hospital Geelong, Geelong, VIC, Australia
| | - Nicholas G. Paltoglou
- Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia
- St. John of God Hospital Geelong, Geelong, VIC, Australia
| | - Varun Arora
- Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia
- St. John of God Hospital Geelong, Geelong, VIC, Australia
| | - Kevin Eng
- Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia
- St. John of God Hospital Geelong, Geelong, VIC, Australia
| | - Stephen D. Gill
- Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia
- St. John of God Hospital Geelong, Geelong, VIC, Australia
| |
Collapse
|
23
|
Sims LA, Aibinder WR, King GJW, Faber KJ. The Unsalvageable Radial Head in Patients Aged 30 Years and Younger. J Hand Surg Am 2021; 46:989-997. [PMID: 34303566 DOI: 10.1016/j.jhsa.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/05/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Concern exists regarding the use of radial head arthroplasty (RHA) in younger patients. This study assessed clinical, functional, and radiographic outcomes of RHA in patients aged 30 years and younger. METHODS A retrospective review identified 26 elbows that underwent a smooth stem modular RHA in patients aged 30 years and younger at a median follow-up of 3.3 years clinically and 2.9 years radiographically. The mean age was 24 ± 5 years. Indications were acute trauma in 13 patients and chronic pathologies in the remaining 13, and these 2 groups were evaluated separately. Patients underwent clinical, functional, and radiographic evaluation. RESULTS Average arc of motion was 137° ± 16° in the cohort with acute trauma and 120° ± 24° in the cohort with chronic pathologies. Mean Patient-Rated Elbow Evaluation scores were 23 ± 18 (acute) and 31 ± 19 (chronic). Mean Quick Disabilities of the Arm, Shoulder, and Hand scores were 18 ± 15 (acute) and 23 ± 20 (chronic). Average Mayo Elbow Performance Index scores were 90 ± 9 (acute) and 80 ± 13 (chronic). Severe capitellar erosion was present in 1 patient (4%) in the cohort with chronic pathologies. Radiographic stem lucency was seen in all cases with 10 of these (38%) graded as severe. Moderate-to-severe ulnohumeral arthritis developed in 4 patients (15%), 3 of whom were in the chronic reconstruction group. Two patients (8%) required reoperation, 1 for persistent instability and 1 for stiffness, both in the cohort with chronic pathologies. CONCLUSIONS For acute trauma and challenging chronic conditions involving the radial head in patients aged 30 years and younger, a smooth stem modular RHA is an option. Although reoperation rates based on this series are low, osteoarthritis is common when used for posttraumatic conditions and severe radiographic stem lucency was seen in greater than one-third of patients. These concerning features warrant close follow-up, and further long-term outcomes are needed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Laura A Sims
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; University of Saskatchewan, Saskatoon Orthopedic and Sports Medicine Centre, Saskatoon, Saskatchewan, Canada.
| | - William R Aibinder
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; State University of New York Downstate Medical Center, Brooklyn, NY
| | - Graham J W King
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada
| | - Kenneth J Faber
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada
| |
Collapse
|
24
|
Abstract
Approximately 4.1% of all fractures in the elderly involve the elbow. Most elbow injuries in geriatric patients occur as the result of low-energy mechanisms such as falls from standing height. Elbow injuries in elderly patients present complex challenges because of insufficient bone quality, comminution, articular fragmentation, and preexisting conditions, such as arthritis. Medical comorbidities and baseline level of function must be heavily considered in surgical decision making.
Collapse
Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Julie Switzer
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Chad Myeroff
- TRIA Orthopedic Center, 155 Radio Drive, Woodbury, MN 55125, USA.
| |
Collapse
|
25
|
Nolte PC, Tross AK, Groetzner-Schmidt C, Jung MK, Porschke F, Grützner PA, Guehring T, Schüler S, Schnetzke M. Risk Factors for Revision Surgery Following Radial Head Arthroplasty without Cement for Unreconstructible Radial Head Fractures: Minimum 3-Year Follow-up. J Bone Joint Surg Am 2021; 103:688-695. [PMID: 33587514 DOI: 10.2106/jbjs.20.01231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision rates following radial head arthroplasty (RHA) for unreconstructible radial head fractures (RHFs) differ vastly in the literature, and little is known about the risk factors that are associated with revision surgery. The purposes of this study were to assess the revision rate following RHA and to determine the associated risk factors. METHODS A total of 122 patients (mean age, 50.7 years; range, 18 to 79 years) with 123 RHAs who underwent RHA for unreconstructible RHFs between 1994 and 2014 and were ≥3 years out from surgery were included. Demographic variables, injury and procedure-related characteristics, radiographic findings, complications, and revision procedures were assessed. Cox regression analysis was performed to identify the risk factors that were associated with revision surgery following RHA. RESULTS The median follow-up for the study cohort was 7.3 years (interquartile range [IQR], 5.1 to 10.1 years). All of the patients had unreconstructible RHFs: Mason-Johnston type-IV injuries were the most prevalent (80 [65%]). One or more associated osseous or ligamentous injuries were seen in 89 elbows (72.4%). The median time to surgery was 7 days (IQR, 3 to 11 days). Implanted prostheses were categorized as rigidly fixed (65 [52.8%]) or loosely fixed (58 [47.2%]). A total of 28 elbows (22.8%) underwent revision surgery at a median of 1.1 years (IQR, 0.3 to 3.8 years), with the majority of elbows (17 [60.7%]) undergoing revision surgery within the first 2 years. The most common reason for revision surgery was painful implant loosening (14 [29.2% of 48 complications]). Univariate Cox regression suggested that Workers' Compensation claims (hazard ratio [HR], 5.48; p < 0.001) and the use of an external fixator (HR, 4.67; p = 0.007) were significantly associated with revision surgery. CONCLUSIONS Revision rates following RHA for unreconstructible RHFs are high; the most common cause for revision surgery is painful implant loosening. Revision surgeries are predominantly performed within the first 2 years after implantation, and surgeons should be aware that Workers' Compensation claims and the use of an external fixator in management of the elbow injury are associated with revision surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Philip-C Nolte
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Anna-K Tross
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinna Groetzner-Schmidt
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Matthias K Jung
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Felix Porschke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Paul A Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Thorsten Guehring
- Department of Shoulder and Elbow Surgery, Sports Medicine & Traumatology, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schnetzke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany.,German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| |
Collapse
|
26
|
Lobo-Escolar L, Abellán-Miralles C, Escolà-Benet A. Outcomes of press-fit radial head arthroplasty following complex radial head fractures. Orthop Traumatol Surg Res 2021; 107:102645. [PMID: 32768276 DOI: 10.1016/j.otsr.2020.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Press-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors. HYPOTHESIS Complex radial head fractures treated with press-fit radial head prosthesis would have a favourable outcome. MATERIAL AND METHODS Data on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analysed. Post-surgery clinical and X-rays assessments included a post-discharge evaluation of function. Standardised methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales. RESULTS Forty-five patients were recruited and 71% were classified in Mason IV and 62.2% had the "terrible triad". Re-operation was performed in 26.7% and prosthesis removal in 15.6%. Mean follow-up was 140.8 months (95% CI 117.7-164) and prosthesis survival was 69.5% at 24 months. Mean MEPS before re-operations was 86.3±15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more "associated injuries" (p=0.05), but not the terrible triad; and in patients with radiological "loosening" signs (p<0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low. DISCUSSION Several studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favourable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavourable outcome. CONCLUSION Treatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation. LEVEL OF EVIDENCE Level IV; case series; treatment study.
Collapse
Affiliation(s)
- Luis Lobo-Escolar
- Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, Sant Cugat, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - César Abellán-Miralles
- Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, Sant Cugat, Barcelona, Spain
| | - Anna Escolà-Benet
- Department of Orthopaedics & Traumatology Surgery, Hospital Universitario General de Cataluña, Sant Cugat, Barcelona, Spain
| |
Collapse
|
27
|
Factor S, Rotman D, Pritsch T, Allon R, Tordjman D, Atlan F, Rosenblatt Y. Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases. Shoulder Elbow 2021; 13:213-222. [PMID: 33897853 PMCID: PMC8039757 DOI: 10.1177/1758573219897859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/29/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Severe radiocapitellar pathologies represent a unique problem in the pediatric population, as radial head excision can lead to substantial long-term complications. We present a case series of four pediatric patients treated by a novel technique-radial head excision followed by Achilles allograft interposition arthroplasty. METHODS Four children (ages 12-15 years) are described. Their clinical and radiographic outcomes were assessed by a visual analog scale, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire, grip strength, and range of motion. RESULTS At a mean follow-up of two years, the average flexion-extension arc of motion improved from 107° to 131°, and the rotation arc improved from 100° to 154°. The average visual analog scale, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand scores were 2, 92.5, and 11.5, respectively. Two patients required subsequent additional procedures-manipulation under anesthesia and ulnar shortening osteotomy. Proximal migration of the radius was observed in three out of the four patients. DISCUSSION Combined radial head excision and Achilles allograft interposition arthroplasty represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with good results in terms of clinical and functional outcomes as well as patient satisfaction in the short-medium term.
Collapse
Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shai Factor, Orthopedic Division, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel.
| | - Dani Rotman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raviv Allon
- Rappaport Faculty of Medicine, The Technion—Israel Institute of Technology, Haifa, Israel
| | - Daniel Tordjman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
28
|
Antoni M, Ginot G, Mereb T, Clement X, Eichler D, Kempf JF, Clavert P. Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors. Orthop Traumatol Surg Res 2021; 107:102814. [PMID: 33482405 DOI: 10.1016/j.otsr.2021.102814] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND One of the treatment options for comminuted radial head fractures is radial head arthroplasty (RHA), especially when the elbow is also dislocated. While the clinical outcomes of RHA have been well documented, the incidence of post-traumatic osteoarthritis after RHA and its risk factors are not well known. OBJECTIVE To determine the incidence of post-traumatic elbow osteoarthritis (humeroulnar and humeroradial joints) after RHA and identify its risk factors. METHODS All patients who underwent RHA at our hospital between 2008 and 2016 were included retrospectively. The inclusion criteria were primary RHA, recent radial head fracture (isolated or associated with elbow dislocation), minimum 1 year of follow-up, clinical and radiographic examination at final assessment. The exclusion criteria were pre-existing elbow osteoarthritis, RHA revision, multiple fractures of the ipsilateral upper limb or polytrauma. The final assessment consisted of a clinical examination [joint range of motion (ROM) and Mayo Elbow Performance Score (MEPS)] and standard radiographs. The correlation between the incidence and severity of osteoarthritis and various risk factors was determined. RESULTS Seventy-three patients were included in the analysis with a mean age of 56 years (21-85). The injuries consisted of 41 terrible triad, 15 isolated radial head fractures, 11 Monteggia fractures and 6 transolecranon fracture-dislocations. The mean follow-up was 3.4 years (1-10.9). At the final assessment, osteoarthritis was visible in the humeroulnar compartment in 56% of cases and in the humeroradial compartment in 72% of cases. There was a statistical correlation between the presence of humeroulnar osteoarthritis at the final assessment and ROM in flexion-extension (p=0.003), MEPS (p<0.001), duration of immobilization (p=0.03) and presence of posterior subluxation on immediate postoperative radiographs (p=0.012). The correlation between humeroradial osteoarthritis at the final assessment and ROM in flexion-extension (p=0.0054), RHA implant position (p<0.01), and unipolar configuration (p=0.027) was statistically significant. CONCLUSION In our study, elbow osteoarthritis incidence after RHA was 56% in the humeroulnar joint and 72% in the humeroradial joint. RHA implant placement, posterior subluxation immediately postoperative and the duration of immobilization were significantly corelated with osteoarthritis. LEVEL OF EVIDENCE IV; case series without control group.
Collapse
Affiliation(s)
- Maxime Antoni
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France.
| | - Geoffrey Ginot
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - Thomas Mereb
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - Xavier Clement
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - David Eichler
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - Jean-François Kempf
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - Philippe Clavert
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| |
Collapse
|
29
|
Klug A, Gramlich Y, Wincheringer D, Hoffmann R, Schmidt-Horlohé K. Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases. J Hand Surg Am 2021; 46:27-35. [PMID: 32798123 DOI: 10.1016/j.jhsa.2020.05.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/24/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to study the epidemiology of radial head fractures within a single national registry database while analyzing trends in available treatments. METHODS A retrospective analysis of data from 2007 to 2016 provided by a national inpatient database registry was performed using the International Classification of Diseases code for radial head fractures and associated German Procedure Classification (OPS) codes. All surgical interventions were evaluated according to fracture type, patient sex and age, and distribution differences over the last decade to detect changes in the treatment trends. The number of major revision procedures was identified and the revision burden for each procedure calculated. RESULTS Overall, 70,118 radial head fractures were included, with the annual number rising over 20% during this period. Women were significantly older than men (peak incidence, 55-64 years vs 30-39 years) and more frequently injured (women-to-men, 1.3:1). Surgical interventions increased during the study period, with locking plate fixation of comminuted fractures and radial head arthroplasty (RHA) becoming increasingly performed while radial head resections decreased. The revision burden differed significantly between the fixation techniques, with an increased occurrence of RHA revision procedures more recently. CONCLUSIONS The data show a higher number and incidence of surgical procedures, especially for comminuted radial head fractures over the study period. Open reduction and internal fixation remains the most frequently used option, with the use of new fixation devices (eg, locking plates) increasing. The use of RHA more than doubled over the past 10 years while the number of radial head resections decreased. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Dennis Wincheringer
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Kay Schmidt-Horlohé
- Orthopaedicum Wiesbaden-Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Wiesbaden, Germany
| |
Collapse
|
30
|
Baek CS, Kim BS, Kim DH, Cho CH. Short- to mid-term outcomes of radial head replacement for complex radial head fractures. Clin Shoulder Elb 2020; 23:183-189. [PMID: 33330256 PMCID: PMC7726358 DOI: 10.5397/cise.2020.00325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.
Collapse
Affiliation(s)
- Chung-Sin Baek
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
31
|
Wang J. The serious full-length forearm injury - a case report and literature review. BMC Musculoskelet Disord 2020; 21:381. [PMID: 32539757 PMCID: PMC7296690 DOI: 10.1186/s12891-020-03394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background Among upper limb injuries, carpal bone fractures and dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow are serious and relatively rare injuries. These injuries require surgical intervention. The surgical method is difficult, and the treatment effect is poor. These injuries have not been described in the same limb in the literature. Case presentation A 21-year-old male patient fell from a height in our institution and sustained multiple injuries, including carpal bone fracture-dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow of his right upper limb. After 2 surgeries and rehabilitation, he returned to work. We reviewed available reviews and related literature on serious upper-limb damage. Conclusions Full-length forearm injury is very rarely encountered, and the management of such fractures is difficult. Radial head replacement with a metal prosthesis, reconstructed the IOM with Tightrope, and fixed the DRUJ with a K-wire pin is appropriate treatment.
Collapse
Affiliation(s)
- Jun Wang
- Department of orthopedic, Xiaoshan 1st People's Hospital, Hangzhou, 311200, China. .,Department of orthopedic, Xiaoshan 1st People's Hospital, No. 199 Shixin Road, Hangzhou, 311201, Zhejiang Province, China.
| |
Collapse
|
32
|
Carbonell-Escobar R, Vaquero-Picado A, Barco R, Antuña S. Neurologic complications after surgical management of complex elbow trauma requiring radial head replacement. J Shoulder Elbow Surg 2020; 29:1282-1288. [PMID: 32284308 DOI: 10.1016/j.jse.2020.01.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty (RHA) has become a successful procedure for addressing acute unreconstructible radial head fractures that compromise elbow stability in complex elbow trauma. The purpose of this study was to investigate the incidence of and risk factors for the development of neurologic complications after surgical treatment of complex elbow fractures that require an RHA. METHODS Sixty-two patients with an unreconstructible radial head fracture and complex elbow instability treated with RHA were included. There were 33 men and 29 women, with a mean age of 54 years (range, 22-87 years). The average follow-up period was 5.2 years (range, 3-16 years). All patients were neurologically intact before surgery. The arthroplasty was implanted through a Kocher approach in 55 cases, whereas a Kaplan approach was used in 7. An uncemented smooth stem arthroplasty (Evolve) was used in 27 patients, and an anatomic ingrowth system (Anatomic Radial Head), in 35. At the time of surgery, 23 patients underwent fixation of a coronoid fracture and 15 underwent plating of the proximal ulna. All patients were clinically examined immediately after surgery and during follow-up to detect any degree of neurologic deficit. Radial and ulnar nerve injuries were classified according to the Hirachi and McGowan classifications, respectively. Functional outcomes were evaluated with the Mayo Elbow Performance Score. RESULTS A complete posterior interosseous nerve palsy occurred postoperatively in 2 patients. Hand function had completely recovered in both at 2 months after surgery without sequelae. Nine patients complained of ulnar nerve symptoms (immediately after surgery in 6 and as delayed ulnar neuropathy in 3). Most patients with ulnar nerve deficits had undergone additional surgical procedures to address ulnar fractures. Among patients with ulnar neuropathies, only 3 complained of mild sensory symptoms at the latest follow-up. No significant differences in range of motion and Mayo Elbow Performance Score were found between patients with and without neurologic complications. Associated olecranon or coronoid fixation and a prolonged tourniquet time were identified as risk factors for neurologic complications. CONCLUSION This study shows that the incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature. Inappropriate retraction in the anterior aspect of the radial neck, a prolonged ischemia time, and concomitant coronoid or olecranon fracture fixation represent the main risk factors for the development of this complication. Although the great majority of patients have full recovery of their nerve function, they should be advised on the risk of this stressful complication.
Collapse
Affiliation(s)
| | | | - Raúl Barco
- Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Hospital Universitario La Paz, Madrid, Spain
| | - Samuel Antuña
- Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
33
|
Radial Head Arthroplasty, Excision and Osteosynthesis in Complex Elbow Fracture-Dislocations in Young Adults: What is Preferred? Indian J Orthop 2020; 54:260-269. [PMID: 33194100 PMCID: PMC7609614 DOI: 10.1007/s43465-020-00136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Complex elbow fractures are common injuries in young adults. Results in recent studies with various operative treatment protocols are equivocal. We compared the results of radial head arthroplasty, excision with osteosynthesis in such injuries at two follow-ups 1 year apart. METHODS Thirty-five patients of complex elbow fracture-dislocations including, posterior/anterior olecranon dislocation of elbow, terrible triad injury, anteromedial facet of coronoid fracture, Type IV Monteggia fracture-dislocation and unclassified elbow dislocation were enrolled. They were managed operatively by standardized protocol similar to McKee et al. radial head reconstruction with miniplates, lag screws or non-operative treatment for undisplaced fractures. Arthroplasty of radial head with cemented prosthesis + LCL repair with suture anchor/transosseous tunnel was done. Coronoid and olecranon fixation was always performed. Patients were evaluated as follows: Q-DASH score, MEPI, pain according to VAS, range of motion, complications and radiographic findings and fracture union, and elbow instability. RESULTS The mean length of follow-up among the patients was 18 months. There were statistically significant differences between the DASH score/MEPS between radial head excision and replacement/reconstruction. Instability was significantly reduced in those with LCL reconstruction. Excising the comminuted radial head without replacement had the worst outcome. Best PROM was reported in patients with osteosynthesis. CONCLUSION Provided a standard protocol is applied, radial head osteosynthesis has preferable outcomes in terms of patient-related outcomes as compared to arthroplasty, although not statistically significant. Radial head excision though has acceptable outcomes but there is a restriction of movements especially flexion-extension. Acceptable rate of complications major or minor warrants need of secondary surgical procedures or a staged treatment.
Collapse
|
34
|
Antoni M, Kempf JF, Clavert P. Comparison of bipolar and monopolar radial head prostheses in elbow fracture-dislocation. Orthop Traumatol Surg Res 2020; 106:311-317. [PMID: 32173303 DOI: 10.1016/j.otsr.2019.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The role of bipolar radial head prostheses (RHP) in elbow fracture-dislocation is controversial, with some reports of poorer stabilization than with monopolar designs. The aim of the present study was to compare mono- versus bi-polar RHPs in elbow fracture-dislocation. The study hypothesis was that mono- and bi-polar RHPs do not differ in clinical and radiological results, complications or revision rates. MATERIAL AND METHODS A single-center retrospective study included 58 patients, with a mean age of 55 years (range, 21-84 years). All received RHP for elbow dislocation with association: terrible triad, Monteggia fracture-dislocation, transolecranal dislocation or divergent dislocation. Two groups were compared: Mono-RHP, with monopolar prosthesis (n=40), and Bi-RHP, with bipolar prosthesis (n=18). All patients underwent clinical and radiological examination at last follow-up. RESULTS Mean follow-up was 42.7 months (range, 12-131 months). There were no significant (p>0.05) inter-group differences in range of motion or Mayo Elbow Performance Score. Mono- versus bi-polar design did not correlate with onset of complications (p=0.89), surgical revision (p=0.71), persistent or recurrent instability (p=0.59), or ulnohumeral (p=0.62) or capitulum (p=0.159) osteoarthritis at last follow-up. DISCUSSION AND CONCLUSION No differences were found between mono- and bi-polar RHPs in the treatment of elbow fracture-dislocation. Clinical and radiographic results were similar, as were complications and revision rates. The literature is inconclusive, reporting contradictory conclusions. We see no contraindications to bipolar RHPs in elbow dislocation with association, notably terrible triad injury. LEVEL OF EVIDENCE III, Retrospective case-control study.
Collapse
Affiliation(s)
- Maxime Antoni
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - Jean-François Kempf
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| |
Collapse
|
35
|
Monoblock polyethylene radial head prosthesis for the treatment of unreconstructable acute radial head fractures with a minimum 1-year follow-up: A retrospective case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Hemmingsen CK, Thillemann TM, Elmengaard B, de Raedt S, Nielsen ET, Mosegaard SB, Stentz-Olesen K, Stilling M. Elbow Biomechanics, Radiocapitellar Joint Pressure, and Interosseous Membrane Strain Before and After Radial Head Arthroplasty. J Orthop Res 2020; 38:510-522. [PMID: 31595550 DOI: 10.1002/jor.24488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023]
Abstract
Complex radial head fracture and elbow instability can be treated with radial head arthroplasty. Good clinical results have been described after this surgical treatment. However, the revision and complication rate reported in the literature is concerning. This might be due to altered kinematics after radial head arthroplasty. Eight human native elbows were examined with dynamic radiostereometric analysis and compared with a radial head arthroplasty. Translations of the radial head in the x-, y-, and z-directions relative to the humerus and the ulna were measured. The radiocapitellar joint pressure was measured using a pressure sensor. The tension within the interosseous membrane was measured using a custom-made strain gauge. After radial head arthroplasty, the radial head was displaced approximately 1.8 mm medially and 1.4 mm distally at the starting point. During unloaded flexion motion the difference in all translations between the native radial head and the radial head arthroplasty was less than 1 mm (95% confidence interval [CI] ± 0.5 mm) (p = 0.001). With loading the difference was less than 1.5 mm (95% CI ± 1.5 mm) (p = 0.001). The mean difference in radiocapitellar joint contact pressure was less than 0.30 MPa (95% CI ± 0.40 MPa) (p = 0.001) during unloaded flexion motion. There were only submillimetre kinematic changes and small changes in joint pressure and interosseous membrane tension after the insertion of a radial head arthroplasty in an experimental setting. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:510-522, 2020.
Collapse
Affiliation(s)
- Chalotte K Hemmingsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Theis M Thillemann
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Elmengaard
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil T Nielsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian B Mosegaard
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
37
|
Viveen J, Kodde IF, Heijink A, Koenraadt KLM, van den Bekerom MPJ, Eygendaal D. Why does radial head arthroplasty fail today? A systematic review of recent literature. EFORT Open Rev 2020; 4:659-667. [PMID: 32010454 PMCID: PMC6986390 DOI: 10.1302/2058-5241.4.180099] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Since the introduction of the radial head prosthesis (RHP) in 1941, many designs have been introduced. It is not clear whether prosthesis design parameters are related to early failure. The aim of this systematic review is to report on failure modes and to explore the association between implant design and early failure.A search was conducted to identify studies reporting on failed primary RHP. The results are clustered per type of RHP based on: material, fixation technique, modularity, and polarity. Chi-square tests are used to compare reasons for failure between the groups.Thirty-four articles are included involving 152 failed radial head arthroplasties (RHAs) in 152 patients. Eighteen different types of RHPs have been used.The most frequent reasons for revision surgery after RHA are (aseptic) loosening (30%), elbow stiffness (20%) and/or persisting pain (17%). Failure occurs after an average of 34 months (range, 0-348 months; median, 14 months).Press-fit prostheses fail at a higher ratio because of symptomatic loosening than intentionally loose-fit prostheses and prostheses that are fixed with an expandable stem (p < 0.01).Because of the many different types of RHP used to date and the limited numbers and evidence on early failure of RHA, the current data provide no evidence for a specific RHP design. Cite this article: EFORT Open Rev 2019;4:659-667. DOI: 10.1302/2058-5241.4.180099.
Collapse
Affiliation(s)
- Jetske Viveen
- Department of Trauma and Orthopedic Surgery, Flinders Medical Centre and University, Adelaide, Australia.,Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Izaak F Kodde
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andras Heijink
- Department of Orthopedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Koen L M Koenraadt
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Martín Fuentes AM, Ramos Pascua LR, Cecilia López D. Correlation between radiographic findings and clinical failure in monopolar radial head replacement. Arch Orthop Trauma Surg 2020; 140:51-58. [PMID: 31515620 DOI: 10.1007/s00402-019-03273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications. MATERIALS AND METHODS We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation. RESULTS The implant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision. CONCLUSIONS Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.
Collapse
Affiliation(s)
- Ana María Martín Fuentes
- Department of Orthopaedic Surgery and Traumatology, University Hospital "Doce de Octubre", Avda. De Córdoba s/n, 28041, Madrid, Spain. .,UCM Department of Surgery, Complutense University of Madrid, Madrid, Spain.
| | - Luis Rafael Ramos Pascua
- Department of Orthopaedic Surgery and Traumatology, University Hospital "Doce de Octubre", Avda. De Córdoba s/n, 28041, Madrid, Spain.,UCM Department of Surgery, Complutense University of Madrid, Madrid, Spain
| | - David Cecilia López
- Department of Orthopaedic Surgery and Traumatology, University Hospital "Doce de Octubre", Avda. De Córdoba s/n, 28041, Madrid, Spain.,UCM Department of Surgery, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
39
|
Abstract
Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. As fixation principles and technology have evolved, so has the ability to render surgical treatment for these fractures. In general, minimally displaced and some displaced fractures may be treated nonoperatively with early motion. Fractures with a block to rotation and displaced fragments with 3 or fewer fragments may be treated with open reduction and internal fixation. Comminuted fractures or those with greater than 3 fragments may be successfully treated with radial head replacement. Associated elbow instability will also influence treatment decisions.
Collapse
|
40
|
Gregori M, Zott S, Hajdu S, Braunsteiner T. Preserving the radial head in comminuted Mason type III fractures without fixation to the radial shaft: a mid-term clinical and radiographic follow-up study. J Shoulder Elbow Surg 2019; 28:2215-2224. [PMID: 31630752 DOI: 10.1016/j.jse.2019.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of multifragment Mason type III fractures is challenging. Open reduction-internal fixation (ORIF), radial head arthroplasty, and in some cases, even radial head resection are the current options; however, each of these treatment methods is associated with characteristic benefits and complications. We present our experience with a radial head salvage procedure in comminuted radial head fractures irrespective of concomitant injuries, which are not accompanied by typical ORIF-related complications. METHODS The first group comprised 29 patients with multifragment Mason type III fractures treated surgically with biological radial head spacers (group S). The fragments were reduced and fixated in an extracorporeal manner, and the reconstructed radial head was placed in its anatomic position without fixation to the shaft. The second group comprised 12 patients treated with conventional ORIF using mini-fragment plates (group P). RESULTS Thirty patients were enrolled to undergo clinical and radiographic follow-up at an average of 76 months (range, 12-152 months). In group S, nonunion at the head-neck junction developed in 70% of the cases; however, the overall Mayo Elbow Performance Index averaged 94.8, which was superior to the average Mayo Elbow Performance Index of 83.1 in group P. Radiographic evaluation showed development of osteoarthritic changes in 75% of patients in group S and 62.5% in group P. None of the patients had wrist-joint pain. CONCLUSIONS Preserving the native radial head in comminuted Mason type III fractures without fixation to the radial shaft is a reliable option. Excellent functional results can be expected; however, the development of osteoarthritis cannot be impeded.
Collapse
Affiliation(s)
- Markus Gregori
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| | | | - Stefan Hajdu
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Tomas Braunsteiner
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
41
|
High Risk of Further Surgery After Radial Head Replacement for Unstable Fractures: Longer-term Outcomes at a Minimum Follow-up of 8 Years. Clin Orthop Relat Res 2019; 477:2531-2540. [PMID: 31389899 PMCID: PMC6903861 DOI: 10.1097/corr.0000000000000876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence for treating acute, unreconstructable radial head fractures in unstable elbows with radial head replacement predominantly consists of short- to mid-term follow-up studies with a heterogenous mix of implants and operative techniques. Data on longer-term patient-reported outcomes after radial head replacement is lacking. QUESTIONS/PURPOSES (1) What proportion of patients undergo revision or implant removal after radial head replacement? (2) At a minimum of 8 years follow-up, what are the patient-reported outcomes (QuickDASH, Oxford Elbow Score, and EuroQol-5D)? (3) What factors are associated with a superior long-term patient-reported outcome, according to the QuickDASH? METHODS Between September 1994 and September 2010, we surgically treated 157 patients for acute radial head fractures. We excluded patients where the radial head was excised (n = 21), internally fixed (n = 15), or replaced as a secondary procedure after failed internal fixation (n = 2). A total of 119 patients who underwent radial head replacement surgery for an acute unreconstructable fracture were included, with a mean age of 50 years (range 15 to 93 ± 19 years), and 53% of patients (63) were women. All but two implants were uncemented, loose-fitting, monopolar prostheses, of which 86% (102) were metallic and 14% (17) were silastic. Implants were only cemented if they appeared unstable within the proximal radius. Silastic implants were used in the earlier series and replaced by metallic implants starting in 2000. We reviewed electronic records to document postoperative complications and prosthesis revision and removal. A member of the local research team (THC, CDC) who was not previously involved in patient care contacted patients to confirm complications, reoperations and to obtain long-term patient-reported outcomes scores. Nineteen patients had died at the point of outcome score collection. Of the remaining 100 patients, 80 were contacted (67% of total cohort), at a median of 11 years (range 8 to 24 years) after injury. The primary outcome measure was the QuickDASH score. RESULTS Of 119 patients, 25% (30) underwent reoperation, with three patients undergoing revision and 27 patients undergoing prosthesis removal at a median of 7 months (range 0 to 125 months). Twenty-one of 30 procedures (70%) occurred within 1 year after implantation. Kaplan-Meier survivorship analysis demonstrated a cumulative implant survival rate of 71%. In the 80 patients contacted, the mean QuickDASH score was 13 ± 14, the mean Oxford Elbow Score was 43 ± 6, and the median EuroQol-5D score was 0.8 (-0.3 to 1.0). After controlling for covariates, we found that prothesis revision or removal (p = 0.466) and prosthesis type (p = 0.553) were not associated with patient-reported outcome, according to the QuickDASH. CONCLUSIONS The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation. Patients must be counselled regarding this risk of secondary intervention, of which the peak risk appears to be within 1 year after implantation. Despite this, patients report low disability according to the QuickDASH at a minimum follow-up of 8 years. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|
42
|
Hackl M, Wegmann K, Hollinger B, El-Zayat BF, Seybold D, Gühring T, Schnetzke M, Schmidt-Horlohé K, Greiner S, Lill H, Ellwein A, Glanzmann MC, Siebenlist S, Jäger M, Weber J, Müller LP. Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases. J Shoulder Elbow Surg 2019; 28:1457-1467. [PMID: 30713065 DOI: 10.1016/j.jse.2018.11.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. METHODS This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22.8%, Mason type IV fracture in 20.9%, terrible-triad injury in 12.8%, Monteggia-like lesion in 13.1%, and Essex-Lopresti lesion in 2.0%. Initial treatment was nonoperative in 30.2%, open reduction and internal fixation (ORIF) in 44.9%, radial head arthroplasty in 16.6%, radial head resection in 3.7%, sole treatment of concomitant injuries in 2.6%, and fragment excision in 2.0%. Up to 3 revision causes and procedures were recorded per case. RESULTS The most common complications were stiffness (67.4%), instability (36.5%), painful osteoarthritis (29.2%), ORIF related (14.8%), nonunion or necrosis (9.2%), radial head arthroplasty related (7.5%), ulnar neuropathy (6.0%), and infection (2.6%). Revision procedures frequently included arthrolysis (42.1%), arthroplasty (24.9%), implant removal (23.6%), ligament repair or reconstruction (23.0%), débridement (14.2%), repeated ORIF (8.2%), and/or radial head resection (7.7%). Mason type I or II fractures were primarily revised because of stiffness and painful osteoarthritis. Complications after Mason type III fractures were predominantly ORIF related. Fracture-dislocations showed a wide range of complications, with instability and stiffness comprising the most common causes of revision. CONCLUSIONS The complications of radial head fractures are characteristic to their classification. Knowledge of these findings might guide surgeons in treating these injuries and may help counsel patients accordingly.
Collapse
Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Boris Hollinger
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, Pforzheim, Germany
| | - Bilal F El-Zayat
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thorsten Gühring
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | - Marc Schnetzke
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | | | | | - Helmut Lill
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | - Alexander Ellwein
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | | | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Münich, Münich, Germany
| | - Martin Jäger
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jörg Weber
- Department of Trauma Surgery, Orthopedics and Hand Surgery, Südstadt Hospital Rostock, Rostock, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| |
Collapse
|
43
|
Laun R, Tanner S, Grassmann JP, Schneppendahl J, Wild M, Hakimi M, Windolf J, Jungbluth P. Primary cemented bipolar radial head prostheses for acute elbow injuries with comminuted radial head fractures: mid-term results of 37 patients. Musculoskelet Surg 2019; 103:91-97. [PMID: 30515741 DOI: 10.1007/s12306-018-0576-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Radial head arthroplasty represents a widely accepted treatment for elbow injuries with non-reconstructible radial head fractures. The aim of this retrospective multicenter study was to assess mid-term results of patients with clearly defined elbow injuries including type III fractures of the radial head according to Mason's classification type III after primary arthroplasty using a cemented bipolar design. MATERIALS AND METHODS In 45 cases a primary cemented bipolar arthroplasty of the radial head was implanted for elbow injuries combined with an acute Mason type III radial head fracture. In all patients associated fractures were detected with preoperative CT scans and ligamentous injuries were evaluated and both were addressed intraoperatively based on a standardized algorithm. Patients with associated injuries other than coronoid fractures and collateral ligament tears were excluded from this study to obtain a more homogenous sample. Clinical and radiological assessment was performed on thirty-seven patients at an average of 5.6 years postoperatively. RESULTS DASH Score, functional rating index of Broberg and Morrey, Mayo Elbow Performance Score, and Mayo Modified Wrist Score confirmed good-to-excellent results in most of the patients. Compared to the unaffected arm range of motion and grip strength were slightly reduced. No elbow instability or loosening of the prosthesis, and minor degenerative changes were detected in a few cases. CONCLUSION Primary cemented bipolar arthroplasty for type III fractures according to Mason's classification in an elbow injury pattern only including associated coronoid fractures and/or ligamentous tears resulted in good-to-excellent mid-term results. These results suggest that primary bipolar radial head arthroplasty combined with distinct treatment of all associated injuries provides good functional outcomes concerning range of motion, elbow stability, and strength in this cohort. However, the associated injuries may influence clinical and radiological outcome and need to be detected, classified, and treated carefully.
Collapse
Affiliation(s)
- R Laun
- Department of Trauma, Orthopedics and Handsurgery, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351, Berlin, Germany
| | - S Tanner
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - J-P Grassmann
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Schneppendahl
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - M Wild
- Department of Trauma, Orthopedics and Handsurgery, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | - M Hakimi
- Department of Trauma, Orthopedics and Handsurgery, Vivantes Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - J Windolf
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - P Jungbluth
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
44
|
Kiechle M, Thannheimer A, Hungerer S, Friederichs J, Bühren V, Von Rüden C. Long-term Outcomes after Primary Radial Head Resection Arthroplasty vs. Acute Radial Head Resection vs. Secondary Prosthetic Removal in Comminuted Radial Head Fractures. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:112-117. [PMID: 31211189 PMCID: PMC6510922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Aim of this study was to compare the clinical and radiological long-term outcomes following operative treatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial head resection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fractures combined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty could contribute to ligament healing. METHODS In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients with comminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinically and radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores. RESULTS After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial head resection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twenty patients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49 points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Broberg and Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards better results and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3 compared to group 2 (P=0.02). CONCLUSION Clinical and radiological long-term results of this study demonstrate a trend towards a better outcome after acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fractures associated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement in cases of comminuted non-reconstructable radial head fractures.
Collapse
Affiliation(s)
- Martin Kiechle
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Andreas Thannheimer
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Sven Hungerer
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Volker Bühren
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Christian Von Rüden
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| |
Collapse
|
45
|
Laumonerie P, Tibbo ME, Kerezoudis P, Gauci MO, Reina N, Bonnevialle N, Mansat P. Short to midterm outcomes of one hundred and seventy one MoPyC radial head prostheses: meta-analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:2403-2411. [PMID: 30062566 DOI: 10.1007/s00264-018-4070-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The MoPyC implant is an uncemented long-stemmed radial head prosthesis that obtains primary press-fit fixation via controlled expansion of the stem. Current literature regarding MoPyC implants appears promising; however, sample sizes in these studies are small. Our primary objective was to evaluate the short- to midterm clinical outcomes of a large sample of the MoPyC prostheses. The secondary objective was to determine the reasons for failure of the MoPyC devices. METHODS Four electronic databases were queried for literature published between January 2000 and March 2017. Articles describing clinical and radiographic outcomes as well as reasons for reoperation were included. A meta-analysis was performed to obtain range of motion, mean Mayo Elbow Performance score (MEPS), radiographic outcome, and reason for failure. RESULTS A total of five articles describing 171 patients (82 males) with MoPyC implants were included. Mean patient age and follow-up were 52 years (18-79) and 3.1 years (1-9), respectively. Midterm clinical results were good or excellent (MEPS > 74) in 157 patients. Overall complication rate was low (n = 22), while periprosthetic osteolysis was reported in 78 patients. Nineteen patients returned to the operating room, with implant revision being required in ten patients. The two primary reasons for failure were (intra-)prosthetic dislocation (n = 8) followed by stiffness (n = 7); no painful loosening was described. CONCLUSION Short- to midterm outcomes of MoPyC prostheses are satisfactory and complications associated are low. The use of stem auto-expansion as a mode of obtaining primary fixation in radial head arthroplasty appears to be an effective solution for reducing the risk of painful loosening.
Collapse
Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Marc Olivier Gauci
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, 06001, Nice, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| |
Collapse
|
46
|
Oppermann J, Burkhart KJ, Löw S, Müller LP. [The proximal radioulnar joint in consideration of the distal radioulnar joint]. DER ORTHOPADE 2018; 47:663-669. [PMID: 29947876 DOI: 10.1007/s00132-018-3590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The movement of the forearm follows a complex interplay of three main components: the proximal and distal radioulnar joint and the interosseous membrane. Injuries to one or even all components have a huge impact on the integrity of this system. The Essex-Lopresti lesion presented a high challenge in clinical diagnostics as well as therapy. Reconstructions of the length and stability are essential for a satisfactory postoperative outcome. If a reconstruction of the radial head by osteosynthesis is not possible, a radial head prosthesis should be implanted in the case of longitudinal instability - avoiding overlapping and/or oversizing. The reconstruction of the interosseous membrane should be considered, as well as the assessment of the distal radioulnar joint and/or the triangular fibrocartilage complex. Various reconstruction options are available in this regard.
Collapse
Affiliation(s)
- J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Köln, Deutschland.
| | | | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Köln, Deutschland
| |
Collapse
|
47
|
Laumonerie P, Declaux S, Reina N, Bonnevialle N, Mansat P, Tibbo ME. Letter to the Editor regarding Hackl et al: "Rare implant-specific complications of the MoPyC radial head prosthesis". J Shoulder Elbow Surg 2018; 27:e79-e80. [PMID: 29433649 DOI: 10.1016/j.jse.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
| | - Stephanie Declaux
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
48
|
Treatment of Radial Head Fractures and Need for Revision Procedures at 1 and 2 Years. J Hand Surg Am 2018; 43:241-247. [PMID: 29169720 DOI: 10.1016/j.jhsa.2017.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/05/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Optimal treatment strategies for radial head fractures remain a subject of debate. We examined national practice patterns in the management of radial head fractures to determine rates of surgical treatment, type of surgery employed, and the incidence of reoperation. METHODS Between 2007 and 2011, we identified patients with radial head fractures along with their associated injuries by International Classification of Diseases, Ninth Revision codes in a national database of orthopedic insurance records. For those who underwent surgery, the type of intervention was identified and each patient was observed to determine whether a subsequent procedure was needed by 1 and 2 years. Chi-square analysis was performed to make comparisons between groups. RESULTS A total of 58,404 radial head fractures were identified between 2007 and 2011; of these, 2,981 underwent surgical treatment (5.1%). Rates of surgical intervention were significantly higher in the context of associated injuries. Among the 2,981 radial head fractures treated surgically, 57.1% underwent open reduction internal fixation (ORIF), 37.9% were treated with radial head arthroplasty, and 4.9% underwent radial head excision. When the surgically treated radial head fracture was associated with a coronoid fracture, elbow dislocation, or proximal ulna fracture, 64.2%, 54.3%, and 47.2% were treated with arthroplasty, respectively, compared with 32.6%, 41.9%, and 52.6% treated with ORIF, respectively. After initial surgical treatment, 12.7% and 14.4% of radial head fractures that underwent ORIF required a secondary surgery at 1 and 2 years, respectively, compared with 8.6% and 10.7% of radial head arthroplasties and 8.3% and 8.4% of resections. CONCLUSIONS Rates of arthroplasty were significantly higher in the context of associated injury, particularly in the setting of a coronoid fracture or elbow dislocation. Fractures initially treated with ORIF had a higher rate of revision surgery at both 1 and 2 years after the index procedure compared with arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
Collapse
|
49
|
Lott A, Broder K, Goch A, Konda SR, Egol KA. Results after radial head arthroplasty in unstable fractures. J Shoulder Elbow Surg 2018; 27:270-275. [PMID: 29332663 DOI: 10.1016/j.jse.2017.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/07/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Whereas most radial head fractures are stable injuries, they sometimes occur as part of complex injury patterns with associated elbow instability. Radial head arthroplasty has been favored in patients with unreconstructable radial head fractures and unstable elbow injuries. The purpose of this study was to review radiographic outcomes, functional outcomes, and complications after radial head arthroplasty for radial head fracture in unstable elbow injuries. METHODS This study was a retrospective review of radial head fractures treated with radial head arthroplasty by a single surgeon during a 15-year period. Demographics of the patients, injury details, operative reports, radiographic and clinical outcomes, and any complications were recorded. Patients were divided into stable and unstable elbow injury groups. RESULTS A total of 68 patients were included. There were 50 unstable fractures that were compared with 18 stable fractures. Patients with unstable radial head fractures with associated elbow dislocation achieved mean flexion and mean forearm rotational arc of motion similar to that of patients with stable radial head fractures. However, supination loss was greater in the unstable group than in the stable fracture group, with a mean difference of 10°. Radiographic outcomes and complication rates did not differ between injury groups. There was no observed decrease in implant longevity in patients with unstable elbow injuries. CONCLUSIONS Radial head arthroplasty is an effective option for treatment of unstable elbow injuries, with recovery of functional elbow range of motion and no difference in complication rate or implant survivorship compared with those patients with stable injuries.
Collapse
Affiliation(s)
- Ariana Lott
- NYU Hospital for Joint Diseases, New York, NY, USA
| | - Kari Broder
- NYU Hospital for Joint Diseases, New York, NY, USA
| | - Abraham Goch
- NYU Hospital for Joint Diseases, New York, NY, USA
| | | | | |
Collapse
|
50
|
Abstract
Background: Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries. Methods: A literature search was performed and the authors’ personal experiences are reported. Results: Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon’s ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation. Conclusion: We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.
Collapse
|