Artroplastia de cúpula radial, experiencia de 11 años. Estudio sobre 82 pacientes

Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study

OBJECTIVES

To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year.

DESIGN

Prospective cohort study.

SETTING

Academic Level 1 trauma center.

PATIENTS/PARTICIPANTS

Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016.

INTERVENTION

Nonoperative treatment of isolated radial head fractures.

OUTCOME MEASUREMENTS

Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5-3-6-12 months.

RESULTS

One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups ( P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year ( P < 0.05).

CONCLUSIONS

Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Dynamic fixation using rigid tape in rehabilitation after surgery of terrible triad injury of the elbow: A randomized trial

OBJECTIVE

The aim of the study was to identify the efficacy of dynamic fixation using rigid tape (RT) in rehabilitation after surgery of terrible triad injury of the elbow (TTIE).

METHODS

Sixty patients who underwent surgery of TTIE were equally randomly divided into RT group and hinged external fixation brace (HEFB) group. Dynamic fixations were applied for 8 weeks. General rehabilitation programs were performed for 3 months, 5 times a week. Follow-up (FU) was at six months. Main outcomes included pain (Visual Analogue Scale, VAS), muscle strength, range of motion (ROM), Elbow Function (Mayo Elbow Performance Index, MEPI), Quality of Life (QOL) (Short Form 36 Questionnaire, SF-36).

RESULTS

There were significant time x group interactions for pain, ROM, MEPI, SF-36 (all p= 0.000), which demonstrated positive efficacy of both the two interventions. Difference at each time-point (except for baseline) of pain and ROM between the two groups was statistically significant (all p< 0.05). Some differences between the two groups were not statistically significant which at 14d on MEPI (p= 0.108) and at 21d (p= 0.259) and FU (p= 0.402) on QOL. Moreover, the increased muscle strength at each time-point had no statistically significant difference between the two groups (all p> 0.05).

CONCLUSIONS

Both RT and HEFB could significantly improve the postoperative functional outcomes of the TTIE. However, early rehabilitation intervention could increase pain, which affected the corresponding function (MEPI) and QOL. Note that this kind of impact was short-term and reversible. The muscle strength and ROM were not affected by the increased severe pain, maintaining a trend of improvement. In addition, the subjects in the RT group improved faster and more efficiently and had better results with pain, ROM, MEPI, and QOL compared to the subjects in the HEFB group.

From radial head to radiocapitellar to total elbow replacement: A case report

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Overstuffing is a serious yet avoidable complication of radial head arthroplasty.

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Overstuffing severely alters elbow joint kinematics and leads to capitellar erosion.

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Radiocapitellar arthroplasty can be a salvage procedure in such cases.

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Limited clinical data is available thus far regarding radiocapitellar arthroplasty.

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The possibility for early failure due to ulnohumeral erosion has to be considered.

Introduction

Radiocapitellar arthroplasty represents a possible treatment option for isolated osteoarthritis of the radial column. We report the first case of early failure of this procedure.

Presentation of case

We present the case of a 41-year old male who sustained a terrible triad injury to his right elbow and subsequently underwent radial head arthroplasty. Due to overstuffing of the radial head prosthesis, capitellar erosion occurred and radiocapitellar arthroplasty was thus performed. Only one year later, conversion of the radiocapitellar replacement to total elbow arthroplasty was required as a result of progressive ulnohumeral osteoarthritis.

Discussion

According to the currently limited clinical data, radiocapitellar arthroplasty provides satisfactory results. However, biomechanical analysis shows that available prostheses do not sufficiently reproduce the radiocapitellar anatomy. The design of the prosthesis might thus have contributed to the rapid progression of ulnohumeral erosion following radiocapitellar arthroplasty although the poor outcome may also be attributed to the trauma itself along with the inadequate initial treatment.

Conclusions

The indication for radiocapitellar arthroplasty warrants careful consideration given the results of biomechanical analysis and the early failure due to progressive ulnohumeral erosion seen in the present case.