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Cha SM, Lee SH, Ga IH, Kim YH, Lee SH. Usefulness of multiple bioabsorbable Mg screws/K‑wires for comminuted radial head fractures. INTERNATIONAL ORTHOPAEDICS 2024; 48:2165-2177. [PMID: 38717609 DOI: 10.1007/s00264-024-06208-2] [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: 02/07/2024] [Accepted: 04/30/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE We hypothesized that multiple absorbable screws/K-wires would be effective for native head preservation in comminuted radial head fracture fixation (com-RHFs). METHODS Seventeen patients who met the inclusion criteria between 2018 and 2020 were included. Radiologic findings indicating proper union and clinical outcomes such as the range of elbow motion, visual analog scale score, and Mayo Elbow Performance Score were assessed prospectively after surgery and at least three years of follow-up. RESULTS The mean follow-up period was 4.6 years. Eleven, one, three, and two patients presented with isolated com-RHFs, type 2 (accompanied injury of medial collateral ligament), type 4 ("terrible triad") fractures, and type 5 posterior olecranon fracture-dislocations, respectively. Union was achieved after a mean of nine weeks postoperatively. The head and shaft angles did not differ significantly from the contralateral normal values (p = 0.778 and 0.872, coronal and sagittal, respectively). At the final follow-up, the mean flexion-extension/pronation-supination arcs were 126.47 ± 4.92°/135.59 ± 10.13°, and thus were significantly different from those on the contralateral side (p < 0.001, both), however the arcs were functional ranges for ordinary daily life. Also, functional status was satisfactory in all individuals. The arthritis grade and extent of heterotrophic ossification were satisfactory in all cases, and there were no serious complications requiring revision surgery. CONCLUSIONS Absorbable screw/K-wire fixation for com-RHFs is an option before radial head arthroplasty associated with a low complication rate and no need for revision.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-Ro, Jung-Gu, Daejeon, Korea.
| | - Sang Hyun Lee
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Ho Ga
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-Ro, Jung-Gu, Daejeon, Korea
| | - Yong Hwan Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-Ro, Jung-Gu, Daejeon, Korea
| | - Seung Ho Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-Ro, Jung-Gu, Daejeon, Korea
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Ishibashi S, Shinomiya R, Hayashi Y, Ishikawa M, Adachi N. A Unique Approach to Irreparable Radial Head Fracture Using an Osteochondral Plug: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00003. [PMID: 38968373 DOI: 10.2106/jbjs.cc.23.00645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
CASE An 18-year-old male patient sustained a traumatic injury that resulted in the loss of approximately 50% of the radial head. Subsequently, reconstruction was performed by transplanting an osteochondral plug harvested from the lateral femoral condyle. At the 1-year postoperative follow-up, the patient was pain-free and had a good range of motion. CONCLUSION Using a novel technique, an irreparable radial head fracture was reconstructed using an osteochondral plug from the lateral femoral condyle. Reconstruction with osteochondral plugs may be a treatment option for partial loss of the radial head.
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Affiliation(s)
- Shigeki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Rikuo Shinomiya
- Department of Musculoskeletal Traumatology and Reconstructive Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Yuta Hayashi
- Department of Musculoskeletal Traumatology and Reconstructive Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
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Perloff EM, Crijns TJ, O'Connor CM, Ring D, Marinello PG. Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography. Clin Shoulder Elb 2023; 26:156-161. [PMID: 37316176 DOI: 10.5397/cise.2022.01368] [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: 11/09/2022] [Accepted: 01/14/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. METHODS One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. RESULTS Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." CONCLUSIONS The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.
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Affiliation(s)
- Eric M Perloff
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Tom J Crijns
- Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Casey M O'Connor
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - David Ring
- Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin, Austin, TX, USA
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Avisar E, Persitz J, Shohat N, Tamir E, Assaraf E, Keren T. Does Radial Head Resection Impair Hand and Wrist Function? A Long-Term Follow-Up. J Orthop Trauma 2021; 35:e486-e490. [PMID: 33771963 DOI: 10.1097/bot.0000000000002126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the long-term outcome in patients after radial head resection surgery for isolated Mason type III radial head fractures. DESIGN An observational retrospective case series. SETTING A Hand and Upper-Extremity Surgery Unit in a tertiary care center. PATIENTS Data were collected from files of patients who were operated between the years 1980 and 2020. Of 352 patients who underwent surgery for radial head fractures, 25 patients were eligible and were enrolled in the study. INTERVENTION All participants underwent radial head resection surgery and a follow-up clinical and radiographic evaluation by 2 senior orthopaedic surgeons. OUTCOME MEASUREMENTS Objective evaluation included active range of motion of the elbow and wrist joints, ulnohumeral angle, key pinch and grip measurements, and radiographic imaging of elbow and wrist joints. Subjective evaluation included visual analog scale measurements, disability of arm shoulder and hand questionnaire, Mayo wrist score, Michigan hand outcome, and Oxford elbow score. RESULTS The mean follow-up was 18 years. Mean elbow range of motion and mean grip strength were lower in the operated hand, as compared to the contralateral hand. Mean proximal radial migration was 1.6 mm. Mean results of visual analog scale, disability of arm shoulder and hand, Mayo wrist score, Michigan hand outcome, and Oxford elbow score indicated good functional outcome and high patient satisfaction. CONCLUSIONS In our study population, long-term functional outcomes after radial head resection were encouraging. Thus, this procedure may be considered as a surgical alternative when radial head reconstruction or replacement fails. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Erez Avisar
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Hand & Upper Extremity Surgery Unit, Yitzhak Shamir Medical Center, Tzrifin, Israel ; and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Persitz
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Hand & Upper Extremity Surgery Unit, Yitzhak Shamir Medical Center, Tzrifin, Israel ; and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Tamir
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Assaraf
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Hand & Upper Extremity Surgery Unit, Yitzhak Shamir Medical Center, Tzrifin, Israel ; and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Timoret Keren
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Tzrifin, Israel
- Hand & Upper Extremity Surgery Unit, Yitzhak Shamir Medical Center, Tzrifin, Israel ; and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chaijenkij K, Arirachakaran A, Kongtharvonskul J. Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures: a systematic review and network meta-analysis. Musculoskelet Surg 2021; 105:17-29. [PMID: 33026602 DOI: 10.1007/s12306-020-00679-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 08/05/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Radial head fractures make up approximately 3% of all fractures, and they are the most common elbow fracture in adults. The treatment for comminuted radial head fracture remains controversial. This systematic review was conducted with the aim to compare postoperative outcomes among surgical treatments to identify which method is the best for comminuted radial head fractures. METHODS Relevant studies were identified from Medline and Scopus from inception to February 22, 2020, that reported Mayo Elbow Performance Index (MEPI) score and postoperative complications of either treatment. A network meta-analysis was applied to assess treatment outcomes. Probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). RESULTS Twelve comparative studies and one randomized controlled trial (N = 526 patients) met the inclusion criteria. Interventions included open reduction and internal fixation (ORIF) (N = 210 patient), radial head arthroplasty (RHA) (N = 227 patients) and radial head resection (RHR) (N = 152 patients). A network meta-analysis showed that the MEPI of RHA was significantly higher when compared to ORIF and RHR, with a pooled mean MEPI of 7.28 (1.69, 12.86) and - 7.32 (- 13.21, - 1.43), respectively. In terms of complications, RHA and RHR had lower risk with RRs of 0.61 (0.29, 1.31) and 0.54 (0.24, 1.25) when compared to ORIF. The SUCRA probabilities of RHA and RHR were in the first rank with 99.2% in MEPI and 60.6% in complications, respectively. CONCLUSIONS This study suggests that RHA is the best treatment of choice for efficacy and safety in the treatment of comminuted radial head fracture, while RHR is the safest choice to minimize postoperative complications and enable patients to perform all daily life activities.
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Affiliation(s)
- K Chaijenkij
- Orthopedic Department, College of Sports Science and Technology, Mahidol University, Bangkok, Thailand
| | - A Arirachakaran
- Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - J Kongtharvonskul
- Sport and Orthopedic Center, Samitivej Hospital and Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand.
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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.
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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
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Laumonerie P, Raad M, Tibbo ME, Kerezoudis P, Bonnevialle N, Mansat P. Midterm outcomes of 146 EVOLVE Proline modular radial head prostheses: a systematic review. Shoulder Elbow 2021; 13:205-212. [PMID: 33897852 PMCID: PMC8039765 DOI: 10.1177/1758573219850111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The EVOLVE implant (Wright Medical Technology, Arlington, TN, USA) is a modular loose-fitting radial head prosthesis. The primary objective was to synthesize all available literature investigating the midterm clinical outcomes of the EVOLVE implant. MATERIALS AND METHODS An electronic literature search in Pubmed/Medline, Scopus, EMBASE, and Cochrane library was performed querying for studies published in 2000-2017. Articles describing clinical and radiographical outcomes as well as reoperation were included. Outcomes of interest included range of motion, Mayo Elbow Performance Score, Disabilities of the Arm Shoulder and Hand, radiographic outcome, and reason for reoperation. RESULTS A total of five articles consisting of 146 patients with EVOLVE implants were included. Mean patient age was 57.4 years (range 22-84), and 43.8% were males (n = 64). Mean follow-up was 4.8 years (range 1-14). Mean Mayo Elbow Performance Score and Disabilities of the Arm Shoulder and Hand score were 87.6 (range 30-100) and 18.9 (range 0-82), respectively. Midterm clinical results were good or excellent (Mayo Elbow Performance Score > 74) in 94 patients. Reoperation was observed in 12 patients, with implant revision required in 2 patients. The primary reason for reoperation was persistent stiffness (n = 9). CONCLUSION Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. Loose-fit implant method appears to be a reliable approach to avoid failure of radial head prosthesis by painful loosening.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France,Pierre Laumonerie, Department of Orthopedic
Surgery, Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur
Baylac, Toulouse, 31059, France
| | - Maroun Raad
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | | | - Nicolas Bonnevialle
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
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Hildebrand AH, Zhang B, Horner NS, King G, Khan M, Alolabi B. Indications and outcomes of radial head excision: A systematic review. Shoulder Elbow 2020; 12:193-202. [PMID: 32565921 PMCID: PMC7285979 DOI: 10.1177/1758573219864305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 06/16/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Radial head excision has historically been a common surgical procedure for the operative management of radial head fractures and post-traumatic conditions. With recent advances in other surgical techniques, controversy exists regarding its indications. This review evaluates the indications and outcomes of radial head excision in traumatic and non-traumatic elbow pathology. METHODS Multiple databases were searched for studies involving radial head excision. Screening and data abstraction were conducted in duplicate. Only studies reporting outcomes for radial head excision were included. RESULTS Twenty-seven studies with 774 radial head excision patients were included. The most common indications involved acute excision of comminuted radial head fractures (n = 347) and rheumatoid arthritis (n = 201). Post-operative functional scores after acute excision were reported to be good to excellent. In the chronic setting of rheumatoid disease, radial head excision resulted in improved range of motion, although pain was not effectively relieved. DISCUSSION Outcomes of radial head excision for acute fracture are good to excellent; however, it should not be performed when concurrent or ligamentous injuries are present. Although some studies compared excision to open reduction and internal fixation or replacement, more data are needed to make proper conclusions. The strength of these conclusions is limited by the quality of included literature.
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Affiliation(s)
| | - Betty Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Graham King
- Department of Surgery, Western University, London, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Moin Khan, St Joseph’s Healthcare, Hamilton, 50 Charlton Avenue, East Hamilton, Ontario L8N 4A6, Canada.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Komplikationsmanagement in der operativen Versorgung von Radiusköpfchenfrakturen. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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.
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11
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Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol 2019; 20:15. [PMID: 30904970 PMCID: PMC6431334 DOI: 10.1186/s10195-019-0523-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/01/2019] [Indexed: 01/25/2023] Open
Abstract
The radial head plays a critical role in the stability of the elbow joint and its range of motion. Injuries may occur across a spectrum of severity, ranging from low energy non-displaced fractures to high energy comminuted fractures. Multiple classification systems exist to help characterize radial head fractures and their associated injuries, as well as to guide treatment strategies. Depending on the type of fracture, non-operative management may be possible if early range of motion is initiated. Other options include open reduction and internal fixation or excision followed by arthroplasty. A lateral approach is typically used for adequate surgical exposure. Controversy still remains regarding operative management of more severe fractures, but studies have shown good outcomes after radial head replacement for these fractures. We will review the current treatments available for radial head fractures, highlighting gaps in knowledge, as well as providing recommendations for the care of these injuries. Level of evidence: Level V.
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Affiliation(s)
- Stephanie J Swensen
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Vineet Tyagi
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT, USA
| | - Carlos Uquillas
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Rachel J Shakked
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center at RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ, 07302, USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center at RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ, 07302, USA.
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Nakanishi A, Kawamura K, Omokawa S, Shimizu T, Nakanishi Y, Iida A, Sananpanich K, Mahakkanukrauh P, Tanaka Y. Reverse vascularized bone graft of the lateral distal humerus for non-union of the radial neck fracture: anatomical study and case report. J Plast Surg Hand Surg 2019; 53:20-24. [DOI: 10.1080/2000656x.2018.1520122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Akito Nakanishi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Japan
| | - Takamasa Shimizu
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuaki Nakanishi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Akio Iida
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Kanit Sananpanich
- Department of Orthopedics Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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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.
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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
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Radial Head Resection versus Arthroplasty in Unrepairable Comminuted Fractures Mason Type III and Type IV: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4020625. [PMID: 30112387 PMCID: PMC6077546 DOI: 10.1155/2018/4020625] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022]
Abstract
Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.
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Lum ZC, Huish EG, Trzeciak MA. Radial axial interosseous load (RAIL) test for essex lopresti type injuries. J Orthop 2018; 15:78-80. [PMID: 29657444 DOI: 10.1016/j.jor.2018.01.013] [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: 10/31/2017] [Accepted: 01/12/2018] [Indexed: 11/17/2022] Open
Abstract
Background When approaching radial head and neck fractures, the decision for ORIF, resection, or arthroplasty is often performed intraoperatively. Factors that contribute include ligamentous and bony stability, cartilage injury, mechanical alignment as well as patient factors. Recent data has suggested conventional methods may not be sufficiently sensitive in detecting Essex Lopresti injuries. Here we describe an intraoperative technique that could objectively assess proximal radio-ulnar stability with subsequent disruption of the ligamentous structures. Methods Eight cadaveric specimens were used to evaluate amount of radial proximal migration between three groups of forearms. After radial head resection, proximal migration of the radial shaft was measured in three distinct groups. Group A included intact forearms, Group B included forearms with resected interosseous membranes (IOM), and Group C included forearms with resected interosseous membranes and distal radioulnar joint (DRUJ) disruptions. Results As compared to group A, group B averaged 4 mm of proximal radial migration (p < 0.01), while Group C demonstrated >6 mm of migration (p < 0.01). Conclusion In the setting of a non-repairable radial head, the RAIL test may provide a more objective means of assessing for Essex-Lopresti injuries.
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Affiliation(s)
- Zachary C Lum
- Doctors Medical Center, Orthopaedic Surgery Department, Graduate Medical Education, 1441 Florida Ave, Modesto, CA, 95350, United States of America
| | - Eric G Huish
- Doctors Medical Center, Orthopaedic Surgery Department, Graduate Medical Education, 1441 Florida Ave, Modesto, CA, 95350, United States of America
| | - Marc A Trzeciak
- Doctors Medical Center, Orthopaedic Surgery Department, Graduate Medical Education, 1441 Florida Ave, Modesto, CA, 95350, United States of America
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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.
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Miquel J, Fernández-Muñoz S, Romero A, Pelfort X, Torrens C. Do we publish what we preach? Analysis of Spanish Shoulder and Elbow Surgery Society publication rates. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, Mansat P. The minimum follow-up required for radial head arthroplasty: a meta-analysis. Bone Joint J 2017; 99-B:1561-1570. [PMID: 29212677 DOI: 10.1302/0301-620x.99b12.bjj-2017-0543.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/11/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation. MATERIALS AND METHODS Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up. RESULTS A total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years. CONCLUSION The literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561-70.
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Affiliation(s)
- P Laumonerie
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - N Reina
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Kerezoudis
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - S Declaux
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - M E Tibbo
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - N Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Mansat
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
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Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures-Three-Dimensional Postoperative Accuracy and Clinical Outcome. J Orthop Trauma 2017; 31:e436-e441. [PMID: 28742788 DOI: 10.1097/bot.0000000000000970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10-16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12-24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40 degrees to 3-7 degrees (58%-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.
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Meena PK, Gaba S, Bobade S, Verma R, Borade A, Sonaje J, Chouhan A. Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study. Bull Emerg Trauma 2017. [PMID: 29177173 DOI: 10.18869/acadpub.beat.5.4.453.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. Methods A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. Results The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection group with mean extension lag of 15.7 ± 4.1 (p=0.022) and mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score of 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p<0.001), mean pronation of 59.2 ± 8.4 (p=0.003) and mean Broberg Morrey score of 81.9 ± 5 (p=0.031). Conclusion The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.
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Affiliation(s)
| | - Sahil Gaba
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Sandesh Bobade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Rajendra Verma
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Amrut Borade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Jayesh Sonaje
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Ankit Chouhan
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
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Meena PK, Gaba S, Bobade S, Verma R, Borade A, Sonaje J, Chouhan A. Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study. Bull Emerg Trauma 2017; 5:266-272. [PMID: 29177173 DOI: 10.18869/acadpub.beat.5.4.453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. Methods A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. Results The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection group with mean extension lag of 15.7 ± 4.1 (p=0.022) and mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score of 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p<0.001), mean pronation of 59.2 ± 8.4 (p=0.003) and mean Broberg Morrey score of 81.9 ± 5 (p=0.031). Conclusion The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.
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Affiliation(s)
| | - Sahil Gaba
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Sandesh Bobade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Rajendra Verma
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Amrut Borade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Jayesh Sonaje
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Ankit Chouhan
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
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Do we publish what we preach? Analysis of Spanish Shoulder and Elbow Surgery Society publication rates. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:35-46. [PMID: 29157989 DOI: 10.1016/j.recot.2017.09.004] [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: 01/16/2017] [Revised: 06/30/2017] [Accepted: 09/03/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The purpose of this study is to analyse the publication rate of studies presented as podium presentations in the Spanish Society of Shoulder and Elbow Surgery (SECHC) congresses. METHODS One hundred and twenty-two abstracts presented at the SECHC congresses held in 2007, 2009 and 2011 were included for the purpose of the study. The oral communications were categorized by study type, sample included and follow-up. In June 2017, possible publications of these studies were searched in PubMed. Type of study, delay in publication, journal and impact factor obtained were recorded. The concordance between the information presented at the congress and their subsequent full-text publications was analysed. RESULTS The publication rate was 17.21% (21 of the 122 abstracts studied) after 6 years, with a mean time spent for publications of 36.71 months, and a mean impact factor of 1.51. There were no differences between results initially presented at the congresses and those subsequently published (P>0.05). DISCUSSION The majority of papers presented at SECHC congresses do not end up with a publication. The papers that are published do not usually contain significant differences compared to the content delivered at the congress.
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Akman YE, Sukur E, Circi E, Ozyalvac ON, Ozyer F, Ozturkmen Y. A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:118-122. [PMID: 28065478 PMCID: PMC6197420 DOI: 10.1016/j.aott.2016.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/24/2016] [Accepted: 03/21/2016] [Indexed: 12/02/2022]
Abstract
Objective The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. Methods Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. Results The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. Conclusion With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. Level of evidence Level III, Therapeutic study.
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Affiliation(s)
- Yunus Emre Akman
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Erhan Sukur
- Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Esra Circi
- Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Osman Nuri Ozyalvac
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Is radial head resection the first choice treatment of comminuted radial head fractures without associated instability? Injury 2017; 48:560-562. [PMID: 28069142 DOI: 10.1016/j.injury.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/01/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedics, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands.
| | - Denise Eygendaal
- Department of Orthopaedics, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands; Department of Orthopaedics, Amphia Hospital, Breda, 4819 EV, The Netherlands
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Lenich A, Imhoff AB, Siebenlist S. [Post-traumatic osteoarthritis of the elbow joint : Endoprosthetic options in young patients]. DER ORTHOPADE 2016; 45:844-52. [PMID: 27647165 DOI: 10.1007/s00132-016-3328-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In young patients, post-traumatic osteoarthritis of the elbow is a rare condition. Whereas clinical manifestations often differ from radiological findings, pain and stiffness are variably combined in symptomatic forms. In deciding whether to perform surgery, the patient's age, activity level, and symptoms, as well as the location and severity of the osteoarthritis have to be taken into account. Elbow joint instability has to be identified to stop the post-traumatic osteoarthritic progress. If joint preserving surgical methods fail, diverse options for partial or total joint replacement are available. THERAPY The treatment goal in young patients, therefore, is to reduce pain with a sufficient range of elbow motion.
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Affiliation(s)
- A Lenich
- Orthopädie, Unfall-, Handchirurgie und Sportorthopädie, Helios Klinikum München West, Steinerweg 5, 81245, München, Deutschland.
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Siebenlist
- Abteilung und Poliklinik für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
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Lópiz Y, González A, García-Fernández C, García-Coiradas J, Marco F. Comminuted fractures of the radial head: resection or prosthesis? Injury 2016; 47 Suppl 3:S29-S34. [PMID: 27692103 DOI: 10.1016/s0020-1383(16)30603-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION At present, surgical treatment of comminuted radial head fractures without associated instability continues to be controversial. When anatomical reconstruction is not possible, radial head excision is performed. However, the appearance of long-term complications with this technique, along with the development of new radial head implants situates arthroplasty as a promising surgical alternative. The purpose of the present study was to compare the mid-term functional outcomes of both techniques. MATERIALS AND METHODS A retrospective study was performed between 2002 and 2011 on 25 Mason type-III fractures, 11 patients treated with primary radial head resection and 14 who received treatment of the fracture with metal prosthesis. At the end of follow-up, patients were contacted and outcomes evaluated according to: Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand score (DASH) and strength measurement. Radiographic assessment (proximal migration of the radius, osteoarthritic changes, and signs of prosthesis loosening) was also performed. RESULTS The average age of the sample was 53.7 years in the resection group, and 54.4 years in the replacement group, with a mean follow-up of 60.3 and 42 months respectively. According to the MEPS scale, there were 6 excellent cases, 3 good and 2 acceptable in the resection group, and 6 excellent cases, 3 good, 3 acceptable, and 2 poor in the prosthesis group. The mean DASH score were 13.5, and 24.8 for the resection and the replacement group respectively. We found one postoperative complication in the resection group (stiffness and valgus instability) and 6 in the replacement group: 3 of joint stiffness, 1 case of prosthesis breakage, and 2 neurological injuries. CONCLUSIONS Although this is a retrospective study, the high complication rate occurring after radial head replacement in comparison with radial head resection, as well as good functional results obtained with this last technique, leads us to recommend it for comminuted radial head fractures without associated instability.
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Affiliation(s)
- Yaiza Lópiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain.
| | - Ana González
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Javier García-Coiradas
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
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Vanni S, Marenco S, Calò M, Battiston B. Resection arthroplasty after failure of a radial head prosthesis: a case report. Case Reports Plast Surg Hand Surg 2016; 3:28-31. [PMID: 27583266 PMCID: PMC4996060 DOI: 10.3109/23320885.2016.1167607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
Abstract
Radial head represents a secondary elbow stabilizer for varus-valgus and postero-lateral stress. In complex fractures, that cannot be synthesized, the presence of associated ligament injuries makes radial head replacement necessary to restore elbow stability. This study evaluates how the elbow responds to a prosthetic removal after a complex injury repair.
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Affiliation(s)
- Stefania Vanni
- Department of Orthopedic and Traumatology, CTO Hospital, Turin, Italy
| | - Stefano Marenco
- Department of Orthopedic and Traumatology, CTO Hospital, Turin, Italy
| | - Michel Calò
- Department of Orthopedic and Traumatology, CTO Hospital, Turin, Italy
| | - Bruno Battiston
- Department of Orthopedic and Traumatology, CTO Hospital, Turin, Italy
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Ries C, Müller M, Wegmann K, Pfau DB, Müller LP, Burkhart KJ. Is an extension of the safe zone possible without jeopardizing the proximal radioulnar joint when performing a radial head plate osteosynthesis? J Shoulder Elbow Surg 2015; 24:1627-34. [PMID: 25940383 DOI: 10.1016/j.jse.2015.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal radial fractures are common elbow injuries. Because of the fracture pattern, stability criteria, or plate configuration, a plate position outside the "safe zone" (SZ) may be required in some cases when performing a radial head plate osteosynthesis. We examined the gross anatomy of the radial head and analyzed different so-called low-profile and precontoured radial head and neck plates with respect to the SZ. MATERIALS AND METHODS Macroscopic measurements of the radial head and neck of 22 formalin-fixed human cadaveric upper extremities were obtained. The SZ was determined by maximum forearm rotation. If the edge of a plate could be extended beyond the respective SZ boundary without jeopardizing the proximal radioulnar joint (PRUJ) in maximum forearm rotation, a new plate-specific SZ boundary was set. RESULTS The mean SZ was 133° (SD, 14°). Among the 5 plates studied, only the 2 radial neck designs allowed the anterior edge of the plate to partially pass the lesser sigmoid notch of the ulna and consequently afforded a significant extension of the SZ in maximum pronation. All 3 radial head designs had to remain within the SZ to avoid interference with the PRUJ. A safe plate position depends on individual plate dimensions, particularly the proximal plate width, and the diameter of the radial head. The smaller the head diameter, the more accurately a plate must be placed within the SZ. CONCLUSIONS If an extension of the SZ in radial head plate osteosynthesis is not essential, we recommend respecting the SZ to minimize the possibility of interference with the PRUJ.
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Affiliation(s)
- Christian Ries
- Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Marcel Müller
- Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany
| | - Kilian Wegmann
- Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Doreen B Pfau
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Lars P Müller
- Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Klaus J Burkhart
- Department for Shoulder Surgery, Rhön-Klinikum, Bad Neustadt, Germany
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Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop Relat Res 2014; 472:2136-43. [PMID: 24549774 PMCID: PMC4048424 DOI: 10.1007/s11999-014-3516-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND When treating complex radial head fractures, important goals include prevention of elbow or forearm instability, with restoration of radiocapitellar contact essential. When open reduction and internal fixation cannot achieve this, radial head replacement is routinely employed, but the frequency of and risk factors for prosthesis revision or removal are not well defined. QUESTIONS/PURPOSES We determined (1) the frequency of prosthesis revision or removal after radial head replacement for acute complex unstable radial head fractures, (2) risk factors for revision or removal, and (3) functional outcomes after radial head replacement. METHODS We identified from our prospective trauma database all patients over a 16-year period managed acutely for unstable complex radial head fractures with primary radial head replacement. Of the 119 patients identified, 105 (88%) met our inclusion criteria; mean age was 50 years (range, 16-93 years) and 57 (54%) were female. All implants were uncemented monopolar prostheses, of which 86% were metallic and 14% silastic. We recorded further procedures for prosthesis revision or removal for any cause, with a minimum followup of 1 year (n = 105). Cox regression analysis was used to determine independent factors associated with revision or removal when controlling for baseline patient (age, sex, comorbidities) and fracture (location, classification, associated injury) characteristics. Short-term functional outcomes (Broberg and Morrey score, ROM) were determined from retrospective review of clinic followup (n = 74), with a minimum followup of 3 months. RESULTS Twenty-nine patients (28%) underwent prosthesis revision (n = 3) or removal (n = 26) at a mean of 6.7 years (range, 1.8-18 years) after injury. Independent risk factors for removal or revision were silastic implant type and lower age. At a mean of 1.1 years (range, 0.3-5.5 years) after surgery, mean Broberg and Morrey score was 80 out of 100 (range, 40-99). Mean elbow flexion was 133° (range, 90°-159°; SD, 13°), extension 21° (range, 0°-80°; SD, 17°), flexion arc 112° (range, 10°-140°; SD, 25°), pronation 84° (range, 0°-90°; SD, 18°), supination 73° (range, 0°-90°; SD, 28°), and forearm rotation arc 156° (range, 0°-180°; SD, 38°). CONCLUSIONS We demonstrated a high removal or revision rate after radial head replacement for acute unstable complex fractures, with lower age and silastic implants independent risk factors. Younger patients should be counseled regarding the increased risk of requiring further surgery after radial head replacement. Future work should focus on long-term patient-reported outcomes after these injuries. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Post-traumatic osteoarthritis of the elbow. Orthop Traumatol Surg Res 2014; 100:S15-24. [PMID: 24461231 DOI: 10.1016/j.otsr.2013.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
Post-traumatic osteoarthritis of the elbow is an uncommon condition in which the clinical manifestations are often at variance with the radiological findings. In symptomatic forms, pain and stiffness are variably combined. When non-operative management fails, the decision to perform surgery is taken on a case-by-case basis depending on age, activity level, patient discomfort, and osteoarthritis location and severity as assessed by CT scan arthrography. Elbow instability or subluxation should be sought. Post-traumatic elbow osteoarthritis raises difficult therapeutic problems in young patients. The goal of treatment is to obtain a low level of pain with sufficient motion range to ensure good function, while preserving future surgical options and delaying elbow arthroplasty to the extent possible.
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Yalcinkaya M, Bagatur AE, Erdogan S, Zorer G. Resection arthroplasty for Mason type III radial head fractures yield good clinical but poor radiological results in the long term. Orthopedics 2013; 36:e1358-64. [PMID: 24200438 DOI: 10.3928/01477447-20131021-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Long-term clinical and radiographic outcomes of primary resection for Mason type III radial head fractures were evaluated in 13 patients (14 elbows) with a mean age of 38.8 years (range, 20-67 years) at the time of surgery. All patients had isolated radial head fractures without associated injuries. Mean follow-up was 14.7 years (range, 9-26 years). Proximal migration of the radius and the carrying angle were measured, and radiographs were reviewed for degenerative elbow and wrist arthritis and periarticular ossification. Five results were excellent and 9 were good. In 8 cases, the radii had migrated proximally and the carrying angle had increased an average 6.3°; the increases in both ulnar variance and the carrying angle were significant, and a significant negative correlation was found between the carrying angles and the clinical scores. Degenerative changes occurred in 8 elbows and 4 wrists, and periarticular heterotopic ossification was present in 3 elbows. Despite the satisfactory long-term outcomes, radial head resection resulted in proximal migration of the radius and an increase in the carrying angle; in addition, osteoarthritic changes in both elbows and wrists as well as periarticular heterotopic ossification were frequent findings without pronounced functional impairment.
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Lanting BA, Ferreira LM, Johnson JA, Athwal GS, King GJW. The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. Bone Joint J 2013; 95-B:1383-7. [DOI: 10.1302/0301-620x.95b10.31844] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We measured the tension in the interosseous membrane in six cadaveric forearms using an in vitro forearm testing system with the native radial head, after excision of the radial head and after metallic radial head replacement. The tension almost doubled after excision of the radial head during simulated rotation of the forearm (p = 0.007). There was no significant difference in tension in the interosseous membrane between the native and radial head replacement states (p = 0.09). Maximal tension occurred in neutral rotation with both the native and the replaced radial head, but in pronation if the radial head was excised. Under an increasing axial load and with the forearm in a fixed position, the rate of increase in tension in the interosseous membrane was greater when the radial head was excised than for the native radial head or replacement states (p = 0.02). As there was no difference in tension between the native and radial head replacement states, a radial head replacement should provide a normal healing environment for the interosseous membrane after injury or following its reconstruction. Load sharing between the radius and ulna becomes normal after radial head Replacement. As excision of the radial head significantly increased the tension in the interosseous membrane it may potentially lead to its attritional failure over time. Cite this article: Bone Joint J 2013;95-B:1383–7.
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Affiliation(s)
- B. A. Lanting
- London Health Sciences Center, University
Hospital, LHSC, London, Ontario, N6C
5A5, Canada
| | - L. M. Ferreira
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - J. A. Johnson
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - G. S. Athwal
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - G. J. W. King
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
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Kovar FM, Jaindl M, Thalhammer G, Rupert S, Platzer P, Endler G, Vielgut I, Kutscha-Lissberg F. Incidence and analysis of radial head and neck fractures. World J Orthop 2013; 4:80-84. [PMID: 23610756 PMCID: PMC3631956 DOI: 10.5312/wjo.v4.i2.80] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/12/2013] [Accepted: 04/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate several complications like persistent radial head dislocation, forearm deformity, elbow stiffness and nerve palsies, associated with radial head fractures.
METHODS: This study reviewed the clinical records and trauma database of this level I Trauma Center and identified all patients with fractures of the radial head and neck who where admitted between 2000 and 2010. An analysis of clinical records revealed 1047 patients suffering from fractures of the radial head or neck classified according to Mason. For clinical examination, range of motion, local pain and overall outcome were assessed.
RESULTS: The incidence of one-sided fractures was 99.2% and for simultaneous bilateral fractures 0.8%. Non-operative treatment was performed in 90.4% (n = 947) of the cases, surgery in 9.6% (n = 100). Bony union was achieved in 99.8% (n = 1045) patients. Full satisfaction was achieved in 59% (n = 615) of the patients. A gender related significant difference (P = 0.035) in Mason type distribution-type III fractures were more prominent in male patients vs type IV fractures in female patients-was observed in our study population.
CONCLUSION: Mason type I fractures can be treated safe conservatively with good results. In type II to IV surgical intervention is usually considered to be indicated.
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Abstract
Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred. This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence.
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Affiliation(s)
- A D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Abstract
The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities.
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Affiliation(s)
- George Miller
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Ali Humadi
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia,Address for correspondence: Dr. Ali Humadi, Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, Australia. E-mail:
| | - Raghavan Unni
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Raphael Hau
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
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Yoon A, Athwal GS, Faber KJ, King GJW. Radial head fractures. J Hand Surg Am 2012; 37:2626-34. [PMID: 23174078 DOI: 10.1016/j.jhsa.2012.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/03/2012] [Indexed: 02/02/2023]
Abstract
Fractures of the radial head are the most common fractures in the elbow, and they frequently have associated ligamentous, cartilaginous, or other bony injuries. Clinical assessment and radiological investigation allow for accurate diagnosis and the formulation of a management plan. Undisplaced or minimally displaced fractures with no rotational block to motion can be treated nonoperatively with excellent results expected. The minimum amount of displacement in a partial articular radial head fracture required for open reduction and internal fixation to provide a superior outcome to nonoperative management is still unknown. Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement.
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Affiliation(s)
- Albert Yoon
- Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
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Schneiders W, Stryer V, Olbrich A, Rammelt S, Zwipp H. [Open reconstruction of radius head fractures with and without accompanying ligament instability. Treatment results]. Unfallchirurg 2012; 116:1085-91. [PMID: 23052702 DOI: 10.1007/s00113-012-2257-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The treatment of fractures of the radial head is commonly based on the Mason classification. Fractures of the radial head caused by a dislocation of the elbow are summarized as Mason type IV fractures. The purpose of this study was to investigate the outcome and the influence of additional ligamentous injuries after reconstruction of fractures of the radial head. PATIENTS AND METHODS One hundred three patients with a fracture of the radial head were treated by open reduction and internal fixation between 2004 and 2009. Fifty-eight of them could be evaluated at an average of 3.6 years after surgery. Forty-one patients had no additional ligamentous injury and 17 had a fracture combined with complete dislocation of the elbow. At the final follow-up examination, all patients were assessed clinically, bilateral radiographs were taken, and the Broberg and Morrey and Kellgren & Lawrence scores were determined. RESULTS Ten patients had a Mason type II, 31 a Mason type III and 17 a Mason type IV fracture. With regard to the Broberg and Morrey score, patients without ligamentous injury achieved a significantly better functional outcome, with good to excellent results in 97.5% of cases compared to 64.6% for patients with ligamentous injuries. Twelve percent of the patients without ligamentous injury and 47% of the patients with ligamentous injuries developed moderate or severe posttraumatic arthritis. Heterotopic ossification was found in 19.5% of the patients without and in 47% of those with ligamentous injury. CONCLUSION Reconstruction of radial head fractures without ligamentous instability led to significantly superior functional results and lower rates of posttraumatic arthritis and heterotopic ossifications than osteosynthesis of fractures with additional ligamentous injury. In these cases primary endoprosthetic replacement might be considered.
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Affiliation(s)
- W Schneiders
- Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland,
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Early radial head excision for displaced and comminuted radial head fractures: considerations and concerns at long-term follow-up. J Orthop Trauma 2012; 26:236-40. [PMID: 22031038 DOI: 10.1097/bot.0b013e318220af4f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study is to retrospectively review the outcomes of patients with comminuted radial head fractures surgically treated with early radial head excision. DESIGN Retrospective follow-up study. SETTING University orthopaedic trauma center. PATIENTS Forty-two patients with unilateral, isolated, closed, displaced, or comminuted radial head fracture (Mason type 2-10, Type 3-32). INTERVENTION Early radial head excision. MAIN OUTCOME MEASUREMENTS Patients were clinically and radiographically evaluated at an average follow-up of 18 years. The uninjured contralateral limb was used as a comparison. Clinical evaluation was rated using the Broberg and Morrey system, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the visual analog scale (VAS) for pain. RESULTS At last follow-up, 36 patients had no complaints, whereas six admitted to occasional pain. The mean Broberg and Morrey score was 91.2 ± 6.3, and the mean Disabilities of the Arm, Shoulder and Hand score was 10.1 ± 8.8. CONCLUSION Early radial head excision represents a viable option in case of displaced and comminuted fractures. According to the results of this study, it demonstrated a high rate of good results and patient satisfaction, a quick recovery after surgery, and a low rate of complications with durable results at long-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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