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Takahashi R, Kajita Y, Harada Y. Terrible triad injury of the elbow joint treated with total elbow arthroplasty: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:113-117. [PMID: 38323216 PMCID: PMC10840581 DOI: 10.1016/j.xrrt.2023.09.002] [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: 02/08/2024]
Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Wegmann K, Hackl M, Leschinger T, Burkhart KJ, Müller LP. Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system. Arch Orthop Trauma Surg 2021; 141:1525-1539. [PMID: 33057805 PMCID: PMC8354917 DOI: 10.1007/s00402-020-03619-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. METHODS The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. RESULTS In low-grade overlengthening (type I) conservative treatment can be an option. In Types II-IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. DISCUSSION The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.
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Affiliation(s)
- K Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | | | - L P Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
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Abstract
Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint.
Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055
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Affiliation(s)
- Izaäk F Kodde
- Orthopedic Center Antwerp, AZ Monica Hospital, Antwerp, Belgium.,Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Jetske Viveen
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Bertram The
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands.,Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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4
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Burkhart KJ, Wegmann K, Schneider MM, Nietschke R, Hollinger B, Müller LP. Klinische Relevanz des Overlengthenings in der Radiuskopfendoprothetik. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11678-019-00546-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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.
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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
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Raven TF, Schönewald M, Doll J, Banken L, Schmidmaier G, Moghaddam A. Evaluation of MoPyC-prosthesis implantation and the use of angular stable plates in the treatment of comminuted radial head fractures. J Orthop 2019; 16:269-274. [PMID: 30976138 DOI: 10.1016/j.jor.2019.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/22/2019] [Indexed: 11/20/2022] Open
Abstract
Objective Comminuted radial head fractures are disproportionately often accompanied by injuries of the bone or ligaments and can be treated in different ways. Methods 15 patients with a comminuted radial head fracture were treated with an angular stable plate (=G1) and 8 with a MoPyC-prosthesis (=G2). Results G1 shows an average Morrey-score of 83,87 points. Complications occurred in 5/15 patients. Within G2 an average Morrey-score of 86 was achieved. Complications could be shown in 2/8 patients. Conclusion Both the treatment provides a clear individual benefit for the patients and predict promising results for the treatment of comminuted radial head fractures.
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Affiliation(s)
- T F Raven
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center for Trauma Surgery, Orthopaedics and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - M Schönewald
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - J Doll
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - L Banken
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - G Schmidmaier
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - A Moghaddam
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center for Trauma Surgery, Orthopaedics and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
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Raven TF, Schönewald M, Doll J, Banken L, Schmidmaier G, Moghaddam A. Evaluation of MoPyC-prosthesis implantation and the use of angular stable plates in the treatment of comminuted radial head fractures. J Orthop 2019; 16:288-293. [PMID: 30976142 DOI: 10.1016/j.jor.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Comminuted radial head fractures are disproportionately often accompanied by injuries of the bone or ligaments and can be treated in different ways. Methods 15 patients with a comminuted radial head fracture were treated with an angular stable plate (=G1) and 8 with a MoPyC-prosthesis (=G2). Results G1 shows an average Morrey-score of 83,87 points. Complications occurred in 5/15 patients. Within G2 an average Morrey-score of 86 was achieved. Complications could be shown in 2/8 patients. Conclusion Both the treatment provides a clear individual benefit for the patients and predict promising results for the treatment of comminuted radial head fractures.
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Affiliation(s)
- T F Raven
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center for Trauma Surgery, Orthopaedics and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, D-63739, Aschaffenburg, Germany.,HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - M Schönewald
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - J Doll
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - L Banken
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - G Schmidmaier
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - A Moghaddam
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center for Trauma Surgery, Orthopaedics and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, D-63739, Aschaffenburg, Germany.,HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
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Radial shortening osteotomy reduces radiocapitellar contact pressures while preserving valgus stability of the elbow. Knee Surg Sports Traumatol Arthrosc 2017; 25:2280-2288. [PMID: 28238092 DOI: 10.1007/s00167-017-4468-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Shortening osteotomy of the proximal radius might represent a potential salvage procedure in symptomatic radiocapitellar osteoarthritis, which could decrease radiocapitellar load while preserving the native radial head. In an in-vitro biomechanical investigation, we sought to determine whether shortening osteotomy of the proximal radius (1) decreases the radiocapitellar joint pressure upon axial loading and (2) retains valgus stability of the elbow. In addition, the anatomic configuration of the lesser sigmoid notch was evaluated to assess possible contraindications. METHODS Axial loading (0-400 N) and valgus torque (7.5 N m) over the full range of motion were applied to 14 fresh-frozen specimens before and after shortening osteotomy of the proximal radius by 2.5 mm. Radiocapitellar and ulnohumeral load distribution during axial compression was evaluated using a digital pressure mapping sensor. Valgus displacement was analyzed with a 3D camera system. The inclination angle (α) of the lesser sigmoid notch was assessed via 50 CT scans. RESULTS Up to axial loading of 250 N, shortening osteotomy caused a significant decrease in radiocapitellar contact pressures (p < 0.041). Valgus stability of specimens did not differ before and after shortening osteotomy (n.s.). The mean inclination angle (α) of the lesser sigmoid notch was 11.3° ± 6.3°. 46% had an inclination angle of ≤ 10° (type I). 46% had an inclination angle of 11°-20° (type II). In 8%, the inclination angle was >20° (type III). CONCLUSION Shortening osteotomy of the proximal radius can decrease radiocapitellar contact pressures during axial loading of up to 250 N. Primary valgus stability is not relevantly influenced by this procedure. In few patients, shortening osteotomy may cause radioulnar impingement of the radial head at the distal edge of the lesser sigmoid notch due to an inclination angle of >20°. Shortening osteotomy might be a promising treatment option to decrease pain levels in case of isolated radiocapitellar osteoarthritis.
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Burkhart KJ, Hollinger B. [Post-traumatic arthritis in the young patient : Treatment options before the endoprosthesis]. DER ORTHOPADE 2016; 45:832-43. [PMID: 27647164 DOI: 10.1007/s00132-016-3326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the young patient, treatment of post-traumatic elbow arthritis remains difficult. Total elbow arthroplasty must be delayed for as long as possible. Therapy starts with nonoperative treatment. If this fails, operative options can be discussed. TREATMENT AIM The aim of surgery is to provide a functional range of motion with acceptable pain without obstructing future treatment options. THERAPY Patients with pain at terminal extension and/or flexion may benefit from arthroscopic or open debridement. Patients with advanced osteoarthritis and pain throughout the complete range of motion, who are too young for total elbow arthroplasty, are offered interposition arthroplasty or arthrodesis. Arthrodesis of the elbow leads to significant restrictions in daily life due to the complete loss of extension/flexion. Therefore, arthrodesis is only offered as treatment in exceptional circumstances. Interposition arthroplasty is a reasonable option for the young patient without significant bony defects, which may provide a stable, functional flexion arc with an acceptable pain level. Interposition arthroplasty preserves the revision options of re-interposition arthroplasty as well as the withdrawal to total elbow arthroplasty. Partial and total elbow arthroplasty are treatment options of elbow arthritis but are not subjects of this article.
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Affiliation(s)
- K J Burkhart
- Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.
| | - B Hollinger
- Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
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Abstract
The high stability of the elbow joint is provided by the congruent articular surfaces in combination with soft tissue stabilizers. The main osseous contributor of elbow stability is the coronoid, which is therefore referred to as a primary stabilizer. The radial head as a secondary stabilizer together with the medial collateral ligament assures valgus stability and together with the coronoid it assures posterolateral stability. Insufficiency of the osseous stabilizers may lead to difficulties in the treatment of chronic dislocation and complex instability. Thereby reconstruction of the osseous constraints of the elbow joint is not performed in isolation from addressing insufficient soft-tissue stabilizers. Bony stabilizers and reconstructional procedures are discussed in this review.
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