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Ma SB, Lee SK, An YS, Choi HG, Choy WS. Is the 'safe zone' identified in preoperative computed tomography helpful for choosing optimal implant for fixation of radial head fracture? Acta Orthop Belg 2023; 89:709-717. [PMID: 38205765 DOI: 10.52628/89.4.11188] [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: 01/12/2024]
Abstract
The purpose of this study is to assess the clinical significance of the radiologic safe zone based on computed tomography and to compare the outcomes of three different implants for fixation of isolated radial head fractures. We retrospectively reviewed 367 patients who underwent internal fixation for isolated radial head fractures. We newly defined two subtypes of Mason type II fractures associated with the radiographic safe zone (IIA, two-part fracture allowing for safe fixation of plate; IIB, two-part fracture not allowing for safe fixation). 170 patients (CCS group, n = 82; HCS group, n = 31; plate group, n = 57) were investigated with no significant differences in demographics. The range of pronation and supination at 1 month postoperatively (P = 0.04 and P = 0.04) and the range of supination at 6 and 12 months postoperatively (P = 0.03 and P = 0.03) were significantly smaller in the plate group. In Mason type IIB fractures, the average MEPS was higher in the CCS and HSC groups than in the plate group (P = 0.01 and P = 0.02). And the average DASH score was lower in the CCS and HCS groups (P < 0.01 and P < 0.01). Evaluation of the radiologic safe zone is potentially helpful in selecting better surgical fixation option. For type III fractures, 2.3-mm cortical screws would be a better option than Acutrak screws. Plates would not be suitable for type IIB radial head fractures.
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Jordan R, Remtulla M, Jones A, Malik S, Chan S, Shyamalan G. The use of intramedullary devices for adult radial head and neck fractures. A systematic review. Acta Orthop Belg 2023; 89:362-368. [PMID: 37924555 DOI: 10.52628/89.2.9824] [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: 11/06/2023]
Abstract
The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.
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Gray R, Hoekzema N, Rubio F, Heifner J, Imada A, Dark N, Scott K, Mercer D. Avoiding Articular Breakthrough in Screw Fixation of Radial Head Fractures. JSES Int 2022; 6:704-708. [PMID: 35813134 PMCID: PMC9263999 DOI: 10.1016/j.jseint.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Methods Results Conclusion
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Zhang D, Dyer GSM, Earp BE, Blazar P. Complications, Reoperations, and Long-Term Outcomes after Open Reduction Internal Fixation of Mason Classification Type II and Type III Radial Head Fractures. J Hand Microsurg 2021; 15:45-52. [PMID: 36761044 PMCID: PMC9904971 DOI: 10.1055/s-0041-1724223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The objectives of this study were to assess long-term outcomes, complications, and reoperations after open reduction internal fixation (ORIF) of radial head fractures. Materials and Methods 35 adult patients, who underwent ORIF of an isolated, displaced radial head fracture without elbow instability (Mason classification type II or III) at two tertiary care referral centers from 2000 to 2017, were identified. Patient satisfaction, pain, and QuickDASH scores were assessed by telephone follow-up at median 12.9 years. Results The mean age of the 35 patients in our study was 39 years, and 54% were women. The median length of clinical follow-up was 175 days. Postoperative complications occurred in 54% of patients, and reoperations in 23% of patients. Multivariable logistic regression identified fixation with plate and screws versus screws alone as a risk factor for complications and reoperations. The long-term telephone follow-up response rate was 54%. At 13-year median follow-up, the average patient satisfaction was 9.6/10, the average patient-reported pain was 0.7/10, and the average QuickDASH score was 10.5. Conclusion The long-term outcomes of ORIF of Mason classification type II and III radial head fractures are favorable; however, rates of complication and reoperation are notable and may be higher with plate-and-screw fixation.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States,Address for correspondence Dafang Zhang, MD Department of Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115United States
| | - George S. M. Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
| | - Brandon E. Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
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Hoekzema N, Gray R, Orbay J, Rubio F, Vernon L, Imada A, Mercer D. Intraoperative radiographic method of locating the radial head safe zone: the bicipital tuberosity view. J Shoulder Elbow Surg 2020; 29:2668-2673. [PMID: 32844750 DOI: 10.1016/j.jse.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The proximal radius is asymmetrical, is mostly articular, and rotates through a large arc of motion. Because of these anatomic factors, there is limited space for hardware. This is magnified in the setting of complex fractures. The portion of the radial head where a radial head plate can be placed without compromising forearm motion has been termed the "safe zone." We hypothesized that the bicipital tuberosity could be used as a reproducible intraoperative fluoroscopic landmark to confirm radial head plate position in the safe zone. METHODS Seventeen cadaveric radii were evaluated. First, the anatomic safe zone was identified using the method previously described by Caputo et al. A proximal radial plate was then placed in the center of this safe zone. The relationship of the plate to the tuberosity was evaluated, and the angle from the point of the greatest tuberosity profile to the center of the safe zone was measured. RESULTS The maximum profile of the bicipital tuberosity is 166° ± 10° from the center of the safe zone as described by Caputo et al. By use of radiographic imaging, a radial head plate placed directly opposite the bicipital tuberosity will be within the safe zone. This position can be ascertained fluoroscopically with an anteroposterior view of the proximal forearm, in which the surgeon rotates the forearm into full supination. The plate should be placed opposite the bicipital tuberosity as seen on the greatest profile at maximum supination. With this method, the plate will be consistently placed within the safe zone. CONCLUSION The bicipital tuberosity can be used as a consistent radiographic anatomic landmark to ensure proximal radial plate placement within the safe zone. If the proximal radial head plate is placed 166° ± 10° opposite the bicipital tuberosity, a landmark easily identified on intraoperative imaging, the implant will be in the safe zone and will not impinge on the ulna in rotation.
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Affiliation(s)
- Nathan Hoekzema
- Department of Orthopaedic Surgery, University of California, Fresno, CA, USA
| | - Robert Gray
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Chicago, IL, USA
| | - Jorge Orbay
- Miami Hand and Upper Extremity Institute, Miami, FL, USA
| | | | - Lauren Vernon
- Miami Hand and Upper Extremity Institute, Miami, FL, USA
| | - Allicia Imada
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, USA
| | - Deana Mercer
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, USA.
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Abstract
Metadiaphyseal proximal radius fractures blur the distinction between the radial neck and radial shaft fractures. Operative management presents unique technical challenges both in terms of surgical approach and fixation method. We discuss relevant anatomy, safe surgical approach, and options and techniques for fracture fixation. We describe 6 patients who achieved satisfactory functional outcomes, even in cases of severe bone loss secondary to ballistic trauma. An extensile dorsal approach with exposure of the posterior interosseous nerve is recommended when normal soft tissue intervals have not already been extensively disrupted. Robust fixation can be achieved by contouring and repurposing a variety of plates such as a variety of mini fragment plates (2.4 mm T or Y-plates), flexible nails, or even distal radius plates.
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van Riet RP, van den Bekerom MPJ, Van Tongel A, Spross C, Barco R, Watts AC. Radial head fractures. Shoulder Elbow 2020; 12:212-223. [PMID: 32565923 PMCID: PMC7285971 DOI: 10.1177/1758573219876921] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/16/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason-Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.
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Affiliation(s)
- RP van Riet
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium,MoRe Foundation, Antwerp, Belgium,Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Antwerp, Belgium,RP van Riet, Department of Orthopedic Surgery, Monica Hospital, Stevenslei 20, 2100 Antwerp, Belgium.
| | - MPJ van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - A Van Tongel
- Department of Orthopaedics and Traumatology, UZ Gent, Ghent, Belgium
| | - C Spross
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - R Barco
- Upper Limb Unit, Hospital Universitario La Paz, Madrid, Spain
| | - AC Watts
- Upper Limb Unit, Wrightington Hospital, UK
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Factors affecting outcome of partial radial head fractures: A Retrospective Cohort Study. Orthop Traumatol Surg Res 2019; 105:1585-1592. [PMID: 31680018 DOI: 10.1016/j.otsr.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/03/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate which factors will affect range of motion (ROM) and function in partial radial head fractures. The hypothesis is that conservative treatment yields better outcomes. MATERIALS AND METHODS This retrospective comparative cohort study included 43 adult volunteers with partial radial head fracture, a minimum 1-year follow up, separated into a surgical and non-surgical group. Risk factors were: associated injury, heterotopic ossification, worker's compensation, and proximal radio ulnar joint (PRUJ) implication. Outcomes included radiographic ROM measurement, demographic data, and quality of life questionnaires (PREE, Q-DASH, MEPS). RESULTS Mean follow up was 3.5 years (1-7 years). Thirty patients (70%) had associated injuries with decreased elbow extension (-11°, p=0.004) and total ROM (-14°, p=0.002) compared to the other group. Heterotopic ossification was associated with decreased elbow flexion (-9.00°, p=0.001) and fractures involved the PRUJ in 88% of patients. Only worker's compensation was associated with worse scores. There was no difference in terms of function and outcome between patients treated non-surgically or surgically. DISCUSSION We found that associated injuries, worker's compensation and the presence of heterotopic ossification were the only factors correlated with a worse prognosis in this cohort of patients. Given these results, the authors reiterate the importance of being vigilant to associated injuries. LEVEL OF EVIDENCE IV, Retrospective study.
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Gao X, Yin HL, Zhou GJ. Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning. Orthop Surg 2019; 11:879-885. [PMID: 31532071 PMCID: PMC6819192 DOI: 10.1111/os.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/29/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning. Methods From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21–58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow‐up radiographs to monitor related complications were evaluated as well. Results All patients were followed‐up with a mean of 21.8 months (range, 12–28 months). The average range of elbow flexion‐extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85–100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0–14), and the VAS for pain was 0.33 ± 0.78 (range, 0–2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve. Conclusion Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.
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Affiliation(s)
- Xu Gao
- Department of Orthopaedic and Traumatic Surgery, Qingdao University, Qingdao, China
| | - Hai-Lei Yin
- Department of Orthopaedic and Traumatic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
| | - Guang-Jie Zhou
- Department of Orthopaedic and Traumatic Surgery, Qingdao University, Qingdao, China
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Miyamura S, Sakai T, Oka K, Abe S, Shigi A, Tanaka H, Shimada S, Mae T, Sugamoto K, Yoshikawa H, Murase T. Regional Distribution of Articular Cartilage Thickness in the Elbow Joint: A 3-Dimensional Study in Elderly Humans. JB JS Open Access 2019; 4:JBJSOA-D-19-00011. [PMID: 31592501 PMCID: PMC6766381 DOI: 10.2106/jbjs.oa.19.00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
During elbow procedures, reconstruction of the joint (including the articular cartilage) is important in order to restore elbow function; however, the regional distribution of elbow cartilage is not completely understood. The purpose of the present study was to investigate the 3-dimensional (3-D) distribution patterns of cartilage thickness of elbow bones (including the distal part of the humerus, proximal part of the ulna, and radial head) in order to elucidate the morphological relationship among them.
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Affiliation(s)
- Satoshi Miyamura
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kunihiro Oka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Yukioka Hospital, Osaka, Japan
| | - Hiroyuki Tanaka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shoichi Shimada
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuo Mae
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuomi Sugamoto
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Murase
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
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Harna B, Saini RS, Lodhi JS, Sharma S. Radial neck fracture fixation by Metaizeau technique in adults: A case series and review of literature. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1016/j.jotr.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Purpose: To evaluate the use of Metaizeau technique in the treatment of radial neck fracture in adults. Method: A total of eight patients were treated with intramedullary pinning (Metaizeau technique) using titanium elastic nails. All the patients suffered isolated radial neck fracture. Fracture morphology in all the patients had angulation more than 30° and were displaced, tilted with the impacted articular fragment. All the patients had Mason’s type III or Judet’s type II or III fracture. The mean age of patients was 31.3 years, and all were operated within 7 days of suffering the injury. The mean follow-up was 9 months. For subjective evaluation, patients rated their satisfaction for elbow use on a scale of 1–6. Objective assessment includes Mayo elbow performance score, active range of motion of flexion and extension and forearm rotation. Results: The active ranges of motion and hand grip strength were comparable in both upper limbs. Similarly, the range of flexion–extension and pronation–supination were identical. In all cases, the titanium elastic nails had already been removed after 8 weeks with osseous healing of the radial neck. Patients rated their satisfaction for elbow function as very good in six cases and good in two cases. Conclusions: In the present case series, the results of the use Metaizeau technique in adults were promising. The proper selection of the patient and timing of surgery should be considered judiciously. Further large case series is required to ascertain the results. Level of evidence: Level IV.
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Affiliation(s)
- Bushu Harna
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | | | | | - Siddharth Sharma
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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12
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Complex radial head and neck fractures treated with modern locking plate fixation. J Shoulder Elbow Surg 2019; 28:1130-1138. [PMID: 30770311 DOI: 10.1016/j.jse.2018.11.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Internal fixation of complex radial head and neck (CRHN) fractures is difficult, and postoperative complications are common. This study evaluated elbow function and patient clinical status after internal fixation of CRHN fractures with modern locking plates. METHODS We included 40 patients with 41 fractures (1 bilateral lesion). In 25 patients (61%), a concomitant injury was found. Patients were an average age of 46 years (range, 22-70 years). The mean follow-up time was 36 months (range, 2-70 months). Postoperative assessments included evaluation of range of motion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications, revision surgery, and the need for metal removal. RESULTS Of the 34 fractures available for follow-up, 33 (97%) healed well. The mean extension deficit was 6° (range, 0°-30°). The average elbow flexion was 134° (range, 90°-160°), pronation was 70° (range, 30°-90°), and supination was 64° (range, 20°-90°). The Mayo Elbow Performance Score showed a mean of 90 points (range, 65-100 points). We observed no "poor" results. The mean Disability of Arm, Shoulder and Hand score was 16.5 (range, 2.5-58.3; n = 29). All patients continued activity without daily analgesics. There were 12 (34%) complications. In 11 (32%) patients, the plate was removed. CONCLUSIONS CRHN fractures fixed with modern locking plates and treated as an osseoligamentous lesion exhibited promising midterm results. The new fixation devices represent an improvement in the treatment of this difficult and common fracture while reducing the need for joint replacement or radial head resection. Diagnosis and treatment of concomitant injuries should be emphasized.
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Couture A, Hébert-Davies J, Chapleau J, Laflamme GY, Sandman E, Rouleau DM. Involvement of the proximal radial ulnar joint in partial radial head fractures: a novel three-dimensional computed tomography scan evaluation method. Shoulder Elbow 2019; 11:121-128. [PMID: 30936952 PMCID: PMC6434964 DOI: 10.1177/1758573217728492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/15/2017] [Accepted: 08/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Partial radial head fractures (PRHF) can involve the proximal radioulnar joint (PRUJ) or be restricted to the 'safe zone' (SZ) during forearm rotation. The objective of the present study was to develop an assessment method for PRUJ involvement in radial head fractures using axial computed tomography (CT) scans. METHODS The area of the radial head in contact with the PRUJ zone was identified, and defined on 18 cadaveric elbows CT scans; the quantitative relationship between PRUJ zone and radial tuberosity was established. Then, four evaluators validated it on PRHF CT scan axial views, classifying the fractures as involving the PRUJ or not. RESULTS Using the radial tuberosity as the 0° of a 360° circle, the SZ was within 108° to 212° clockwise for a right elbow and counter clockwise for the left elbow. Fifty-five consecutive (30 men, 25 women, mean age of 49 years) partial radial head fracture CT scans were classified: four in the SZ only, three in the PRUJ zone and 48 in both the PRUJ and SZ. The kappa for the inter- and intra-observer agreement was 0.517 and 0.881, respectively. CONCLUSIONS Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. LEVEL OF EVIDENCE Retrospective basic science study. Level III: anatomic study, imaging.
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Affiliation(s)
| | - Jonah Hébert-Davies
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada
| | | | - G. Yves Laflamme
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada
| | - Emilie Sandman
- Université de Montréal, Montreal, QC, Canada,Laboratoire d'imagerie et d'orthopédie, Hôpital du Sacré-Cœur, Research Center, Montreal, Quebec, Canada
| | - Dominique M. Rouleau
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada,Dominique M. Rouleau, C2095-5400 Bouleard Gouin Ouest, Montreal, Quebec H4J 1C5 Canada.
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Abstract
Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex). In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity. Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first). The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation. For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint. Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability. Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function. The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.
Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.
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Affiliation(s)
- Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Arne Buchholz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Karl F Braun
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Kaziz H, Benzarti S, Triki MA, Mouelhi T, Naouar N, Ben Ayeche ML. Outcome of intramedullary pinning of isolated radial neck fractures in adulthood. J Shoulder Elbow Surg 2018; 27:1650-1655. [PMID: 30104099 DOI: 10.1016/j.jse.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of radial neck fractures is controversial and typically depends on displacement. Surgical procedures based on open reduction-internal fixation (ORIF) may lead to several complications, such as avascular necrosis of the radial head, nonunion, malunion, and elbow stiffness. Closed reduction with intramedullary pinning of radial neck fractures, which is commonly used in children, is a viable option for these fractures in adults and may allow for a lower complication rate compared with ORIF. The aim of this study was to report the functional outcome of closed reduction and intramedullary stabilization in isolated radial neck fractures. METHODS Fourteen cases were retrospectively reviewed between January 2007 and December 2016. The inclusion criteria were isolated radial neck fractures of type I to III according to the Mason classification, absence of previous injuries of the elbow, and a minimum of 1 year of follow-up. The Mason classification was used to classify these injuries. At final follow-up, functional assessment was established based on functional scores: Morrey Elbow Score, Elbow Self-Assessment Score, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score. Range of motion was evaluated similarly. RESULTS The mean follow-up period was 86 months. The mean age was 44.2 years. Regarding the functional outcome, 78% of patients claimed satisfaction. Concerning the functional scoring, the mean visual analog scale score was 0.2 (range, 0-4) and the mean Morrey Elbow Score was 95.7 (range, 85-100). The mean QuickDASH score was 6.4 (range, 7-22). The complication rate was 35%. Malunion was observed in 7% of patients. CONCLUSION Intramedullary pinning of radial neck fractures represents a viable technique in adults because of its safety and simplicity. The complication rates are lower than those in other reports of ORIF.
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Affiliation(s)
- Hamdi Kaziz
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia.
| | - Sofien Benzarti
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
| | | | - Thabet Mouelhi
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
| | - Nader Naouar
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
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Sandmann GH, Crönlein M, Neumaier M, Beirer M, Buchholz A, Stöckle U, Biberthaler P, Siebenlist S. Reduction and stabilization of radial neck fractures by intramedullary pinning: a technique not only for children. Eur J Med Res 2016; 21:15. [PMID: 27072673 PMCID: PMC4830037 DOI: 10.1186/s40001-016-0210-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Isolated radial neck fractures occur only in rare cases. The majority of cases are non-displaced or minimally displaced and can be treated conservatively. Conservative treatment, however, might result in secondary displacement and/or malunion. On the other hand, open reduction and internal fixation (ORIF) as standard surgical approach in adults is associated with non-union, implant-related complications and reduced range of motion. For isolated radial neck fractures with an intact radial head, the procedure of centromedullary pinning--as widely used in the treatment of paediatric radial neck fractures--might be an alternative operative technique in adults as well. The purpose of this retrospective case series therefore was to evaluate the functional outcome of radial neck fractures treated by intramedullary pinning. METHODS Between 02/2009 and 12/2014, a total of eight patients with isolated radial neck fractures (Mason type-III; Judet Type II and III) were treated with centromedullary pinning using titanium elastic nails (TEN). The mean age of the patients was 39 years (range 23-90 years) with a mean interval from injury to surgery of 2.9 days (range 1-7 days). Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey Elbow Score (MEPS), the QuickDASH and the Elbow Self Assessment Score (ESAS). Furthermore, follow-up radiographs were evaluated. RESULTS Seven of the eight patients were available for follow-up after a mean of 36 months (range 6-64 months). Patients' satisfaction was rated very good in four cases, good in two cases and sufficient in one case. An unrestricted active ROM compared to the contralateral side for extension-flexion arc and for pronation-supination-arc with full strength was rated in all cases. The Elbow Self Assessment Score was 98.52 ± 1.95 (range 96-100), the calculated Mayo elbow performance score was 95.71 ± 7.32 (range 85-100) and the QuickDASH score was 6.81 ± 10.42 (range 0-27). There were no complications as infection, non-union, heterotopic ossifications or secondary loss of reduction of the radial head. Only one patient complained about pain resulting from an affection of the superficial radial nerve. CONCLUSION In the present cohort, good to excellent results without relevant complications were seen. The technique of intramedullary pinning as described in the treatment of isolated radial neck fractures in children represents a suitable and reliable method in adults as well. In selected cases, this technique can be recommended as an alternative, minimal-invasive approach to the radial head plate osteosynthesis.
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Affiliation(s)
- G H Sandmann
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.,BG Unfallklinik Tübingen, Eberhard-Karls- University, Tuebingen, Germany
| | - M Crönlein
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - M Neumaier
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - M Beirer
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - A Buchholz
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - U Stöckle
- BG Unfallklinik Tübingen, Eberhard-Karls- University, Tuebingen, Germany
| | - P Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - S Siebenlist
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
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