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Klug A, Jakobi T, Schnetz M, Hagebusch P, Gramlich Y, Hoffmann R. Mid-term outcome following radial head arthroplasty in acute trauma: risk factors for poor outcome. J Shoulder Elbow Surg 2023; 32:2140-2151. [PMID: 37327986 DOI: 10.1016/j.jse.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aims of this study were to evaluate the outcomes of a single type of radial head implant in a large cohort of patients at mid-term follow-up and to determine the associated risk factors for inferior functional outcomes. METHODS We performed a retrospective follow-up assessment of 65 patients (33 women and 32 men; mean age, 53.3 years [range, 22-81 years]) who underwent radial head arthroplasty (RHA) for acute trauma between 2012 and 2018, after a minimum follow-up period of 3 years. The Mayo Elbow Performance Score, Oxford Elbow Score, Disabilities of the Arm, Shoulder and Hand score, and Mayo Modified Wrist Score were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following RHA. RESULTS After an average follow-up period of 4.1 years (range, 3-9.4 years), the mean Mayo Elbow Performance Score was 77.2 (standard deviation [SD], 18.9); mean Oxford Elbow Score, 32.0 (SD, 10.6); mean Mayo Modified Wrist Score, 74.6 (SD, 13.7); and mean Disabilities of the Arm, Shoulder and Hand score, 29.0 (SD, 21.2). Average range of motion measured 10° (SD, 15°) in extension, 125° (SD, 14°) in flexion, 81° (SD, 14°) in pronation, and 63° (SD, 24°) in supination. The overall complication and reoperation rates were 38.5% and 30.8%, respectively, with severe elbow stiffness being the most common reason for revision. Patient age >50 years, the use of an external fixator, the presence of accompanying medial collateral ligament injuries, and the development of higher-grade osteoarthritis were associated with a poor outcome. CONCLUSION Satisfactory medium-term outcomes can be achieved using a monopolar, long-stemmed RHA in patients with acute trauma. However, complication and revision rates are high, frequently leading to inferior outcome scores. Additionally, a higher patient age, the use of an external fixator, the presence of accompanying medial collateral ligament injuries, and the occurrence of higher-grade osteoarthritis were associated with a poor outcome; these factors should raise awareness by the treating trauma surgeon.
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Affiliation(s)
- Alexander Klug
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Tim Jakobi
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias Schnetz
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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Scoscina D, Facco G, Luciani P, Setaro N, Senesi L, Martiniani M, Gigante AP. Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement? Musculoskelet Surg 2023; 107:223-230. [PMID: 35429279 DOI: 10.1007/s12306-022-00745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/26/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE This study focused on a comparison of mid-term clinical, functional and radiographic outcomes of adults treated by open reduction and internal fixation (ORIF), radial head prosthesis (RHP) and resection (RHR). METHODS The retrospective evaluation concerned 47 surgically treated patients after a mean follow-up of 53 months. All patients were grouped according to the surgical procedure performed: 15 in the RHP group, 16 in the ORIF group and 16 in the RHR group. At the follow-up, outcome assessment was based on radiographs, range of motion (ROM) and functional rating scores. RESULTS Patients treated by RHR had significantly higher mean age and shorter operation time than other two groups. Compared to ROM, flexion, extension and pronation were significantly worse in patients treated by ORIF than those in the RHP group and the RHR group. Supination was significantly better in the RHP group. However, no statistical differences were observed in functional rating scores among the three groups. Regarding complications, instability was the only cause of revision surgery in the RHP group and the RHR group. On the other hand, the ORIF group revision rate was 50% and secondary displacement was the most frequent cause of failure. CONCLUSION The ORIF group did not show good results with greater elbow stiffness and higher revision rate than the other two techniques. RHR may be suitable for elderly patients with lower functional demands as it reported good clinical results and reduced operation time.
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Affiliation(s)
- D Scoscina
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy.
| | - G Facco
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - P Luciani
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - N Setaro
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - L Senesi
- Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy
| | - M Martiniani
- Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A P Gigante
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
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Mulders MAM, Schep NWL, de Muinck Keizer RJO, Kodde IF, Hoogendoorn JM, Goslings JC, Eygendaal D. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1670-1678. [PMID: 33753275 DOI: 10.1016/j.jse.2021.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Izaäk F Kodde
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Deventer Hospital, Deventer, the Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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Wagner FC, Polossek L, Yilmaz T, Jaeger M, Maier D, Feucht MJ, Südkamp NP, Reising K. Biodegradable magnesium vs. polylactide pins for radial head fracture stabilization: a biomechanical study. J Shoulder Elbow Surg 2021; 30:365-372. [PMID: 32619657 DOI: 10.1016/j.jse.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biodegradable implants have gained increasing importance for the fixation of simple displaced radial head fractures to supersede implant removal and to minimize cartilage destruction. Commonly used polylactide pins still lead to higher rates of secondary loss of reduction compared with metal implants. Alternatively, implants made from a magnesium alloy meanwhile are available in a pin design that hypothetically could perform better than polylactide pins. Because biomechanical data of clinical applications are lacking, the goal of the present study was to biomechanically compare magnesium pins to polylactide pins using a Mason type II radial head fracture model. METHODS Fourteen pairs of fresh-frozen human cadaver radii with a standardized Mason type II radial head fracture were stabilized either by two 2.0-mm polylactide pins (PPs) or two 2.0-mm magnesium pins (MPs). Biomechanical in vitro testing was conducted as 10 cycles of static loading at 0.1 Hz axially and transversally between 10 and 50 N. Afterward, loosening was tested by dynamic load changes at 4 Hz up to 100,000 cycles. Early fracture displacement was measured after 10,000 cycles. Afterward, maximum loads were raised every 10,000 cycles by 15 N until construct failure, which was defined as fracture displacement ≥2 mm. RESULTS MP osteosynthesis showed a tendency toward higher primary stability on both axial (MP: 0.19 kN/mm, PP: 0.11 kN/mm; P = .068) and transversal loading (MP: 0.11 kN/mm, PP: 0.10 kN/mm; P = .068). Early fracture displacement was significantly higher following PP osteosynthesis (MP: 0.3 mm, PP: 0.7 mm; P = .030). The superiority of MP was also significant during cyclic loading, represented in a higher failure cycle (MP: 30,684, PP: 5113; P = .009) and in higher failure loads (MP: 95 N, PP: 50 N; P = .024). CONCLUSION According to our findings, in simple radial head fractures, osteosynthesis with magnesium pins show superior biomechanical properties compared with fractures treated by polylactide pins. Prospective investigations should follow to evaluate clinical outcomes and resorption behavior.
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Affiliation(s)
- Ferdinand C Wagner
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany; G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany.
| | - Larissa Polossek
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany
| | - Tayfun Yilmaz
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany
| | - Matthias J Feucht
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany; Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, TU Munich, Germany
| | - Norbert P Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany; G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany
| | - Kilian Reising
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany; Department of Trauma Surgery, Asklepios Klinikum Hamburg, Germany
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Klug A, Gramlich Y, Wincheringer D, Hoffmann R, Schmidt-Horlohé K. Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases. J Hand Surg Am 2021; 46:27-35. [PMID: 32798123 DOI: 10.1016/j.jhsa.2020.05.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/24/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to study the epidemiology of radial head fractures within a single national registry database while analyzing trends in available treatments. METHODS A retrospective analysis of data from 2007 to 2016 provided by a national inpatient database registry was performed using the International Classification of Diseases code for radial head fractures and associated German Procedure Classification (OPS) codes. All surgical interventions were evaluated according to fracture type, patient sex and age, and distribution differences over the last decade to detect changes in the treatment trends. The number of major revision procedures was identified and the revision burden for each procedure calculated. RESULTS Overall, 70,118 radial head fractures were included, with the annual number rising over 20% during this period. Women were significantly older than men (peak incidence, 55-64 years vs 30-39 years) and more frequently injured (women-to-men, 1.3:1). Surgical interventions increased during the study period, with locking plate fixation of comminuted fractures and radial head arthroplasty (RHA) becoming increasingly performed while radial head resections decreased. The revision burden differed significantly between the fixation techniques, with an increased occurrence of RHA revision procedures more recently. CONCLUSIONS The data show a higher number and incidence of surgical procedures, especially for comminuted radial head fractures over the study period. Open reduction and internal fixation remains the most frequently used option, with the use of new fixation devices (eg, locking plates) increasing. The use of RHA more than doubled over the past 10 years while the number of radial head resections decreased. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Dennis Wincheringer
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Kay Schmidt-Horlohé
- Orthopaedicum Wiesbaden-Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Wiesbaden, Germany
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Haasters F, Helfen T, Böcker W, Mayr HO, Prall WC, Lenich A. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures. BMC Musculoskelet Disord 2019; 20:343. [PMID: 31351457 PMCID: PMC6661091 DOI: 10.1186/s12891-019-2726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.
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Affiliation(s)
- Florian Haasters
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany. .,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Tobias Helfen
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Hermann O Mayr
- Department of Orthopaedics and Traumatology, Freiburg University Hospital, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg im Breisgau, Germany
| | - Wolf Christian Prall
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany.,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Andreas Lenich
- Department of Orthopedic Sports Medicine, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Vannabouathong C, Akhter S, Athwal GS, Moro J, Bhandari M. Interventions for displaced radial head fractures: network meta-analysis of randomized trials. J Shoulder Elbow Surg 2019; 28:578-586. [PMID: 30626538 DOI: 10.1016/j.jse.2018.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to conduct a systematic review of studies comparing treatments for displaced radial head fractures (RHFs) and perform a network meta-analysis of randomized controlled trials (RCTs). METHODS We searched electronic databases and reviewed the reference lists of included studies and prior systematic reviews. We included RCTs and cohort studies that (1) compared treatments for displaced RHFs in adults and (2) reported a functional outcome or postoperative complications. Data from RCTs were synthesized using a Bayesian network meta-analysis. We compared the proportion of patients categorized as "excellent" or "good" according to the Broberg and Morrey scale and the rate of postoperative complications using odds ratios (OR) with 95% credible intervals (CrI). RESULTS We included 20 studies (4 RCTs). The evidence from RCTs examined radial head arthroplasty (RHA), open reduction and internal fixation (ORIF) with metal implants (ORIF-M), and ORIF with biodegradable implants (ORIF-B). The network meta-analysis demonstrated that patients treated with an RHA had greater odds of achieving an "excellent" or "good" score compared with ORIF-M (OR, 22.5; 95% CrI, 2.73-299.58) and ORIF-B (OR, 11.83; 95% CrI, 0.58-324.57). For postoperative complications, RHA patients had a lower odds of experiencing a complication than ORIF-M (OR, 0.15; 95% CrI, 0.01-1.81) and ORIF-B (OR, 0.16; 95% CrI, 0.01-3.06) patients. CONCLUSION The network meta-analysis of RCTs indicated that RHA results in better function and reduced postoperative complications than ORIF-M and ORIF-B over 2 years in the treatment of displaced RHFs.
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Affiliation(s)
| | - Shakib Akhter
- Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - George S Athwal
- Department of Surgery, Western University, London, ON, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Laumonerie P, Tibbo ME, Reina N, Pham TT, Bonnevialle N, Mansat P. Radial head arthroplasty: a historical perspective. INTERNATIONAL ORTHOPAEDICS 2018; 43:1643-1651. [DOI: 10.1007/s00264-018-4082-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022]
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Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients. OBERE EXTREMITAT 2018; 13:112-120. [PMID: 29887917 PMCID: PMC5976694 DOI: 10.1007/s11678-018-0456-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/16/2018] [Indexed: 11/23/2022]
Abstract
Background An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively. Patients and method Between 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16–75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated. Results The average time to surgery after trauma was 50 months (range, 5–360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1–8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1–4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131–15–0° to postoperative flexion/extension of 135–5–0° (gain in flexion: 4.2° and extension: 10.6°). Conclusion Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.
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Zhan Y, Luo CF, Chen YJ. A new method to locate the radial head "safe zone" on computed tomography axial views. Orthop Traumatol Surg Res 2018; 104:71-77. [PMID: 29241814 DOI: 10.1016/j.otsr.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/02/2017] [Accepted: 10/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Direct location of the "safe zone" on a CT axial view is impossible because the radial head is circular in shape. Previous "safe zone" location methods are not appropriate if the physician is unable to visualize the actual radial head. This study aims to introduce a new method to locate the "safe zone" on CT. METHODS CT scans were performed on 20 intact cadaveric upper limbs from 20 different corpses in full pronation and supination. The DICOM-format raw data were then re-sliced and analyzed in Mimics 17.0 (Materialise, Belgium). The radial interosseous border (IB) is shaped like a droplet on the axial view; its axis was selected as our reference line (RL). A parallel line in the radial head axial slice was created, and its position relative to the "safe zone" was studied. Deviation in RL direction was evaluated. RESULTS Safe-zone scope was 114.41°±11.99. The rotation angle from the RL to the safe-zone's anterior and posterior border was 215.03°±5.99 and 100.62°±8.12, respectively. Rotation direction (clockwise or anti-clockwise) depended on relative radius-ulna position. The safe zone was located by determining these two borders. The reference line's direction was stable in the upper half of the IB; its distance to the radial head fovea was 77.33° mm±6.24. CONCLUSIONS The radial head "safe zone" can be located on CT axial view based on the upper half of the IB using this new method. The method is clinically applicable to determine whether postoperative elbow malrotation results from plate impingement.
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Affiliation(s)
- Y Zhan
- Department of orthopaedic surgery, Shanghai Jiaotong university affiliated Shanghai Sixth People's Hospital, 200233 P.R. Shanghai, China
| | - C F Luo
- Department of orthopaedic surgery, Shanghai Jiaotong university affiliated Shanghai Sixth People's Hospital, 200233 P.R. Shanghai, China.
| | - Y J Chen
- Department of orthopaedic surgery, Shanghai Jiaotong university affiliated Shanghai Sixth People's Hospital, 200233 P.R. Shanghai, China.
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Martin DP, Wilt ZT, Cantlon MB, Wang ML. Controversies Surrounding the Management of the Isolated Type-II Radial-Head Fracture. JBJS Rev 2017; 5:e3. [DOI: 10.2106/jbjs.rvw.17.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Viveen J, Doornberg JN, Kodde IF, Goossens P, Koenraadt KLM, The B, Eygendaal D. Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial. BMC Musculoskelet Disord 2017; 18:484. [PMID: 29166890 PMCID: PMC5700741 DOI: 10.1186/s12891-017-1854-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program. If conservative treatment fails, an operative release of the posttraumatic stiff elbow is often performed. The best Evidence-Based rehabilitation protocol for patients after an operative release is unknown to date and differs per surgeon, hospital and country. Options include early- or delayed motion supervised by a physical therapist, immediate continuous passive motion (CPM), (night) splinting and a static progressive or dynamic splinting program. METHODS/DESIGN The SET-Study (Stiff Elbow Trial) is a single-centre, prospective, randomized controlled trial. The primary objective of this study is to compare the active Range of Motion (ROM) (flexion arc and rotational arc) twelve months after surgery between three groups. The first group will receive in-hospital CPM in combination with early motion Physical Therapy (PT) supervised by a physical therapist, the second group will receive only in-hospital early motion PT supervised by a physical therapist and the third group will receive outpatient supervised PT from postoperative day seven till ten. Secondary outcome measures will be Patient Reported Outcome Measures (PROMs) including the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), the quick Disabilities of Arm, Shoulder and Hand (qDASH) score, Visual Analogue pain Scale in rest and activity (VAS), Pain Catastrophizing Scale (PCS), the Short Form (SF)-36, the Centre for Epidemiological Studies Depression Scale Revised (CESD-R) and the Work Rehabilitation Questionnaire (WORQ) for the upper limb. DISCUSSION A successful completion of this trial will provide evidence on the best rehabilitation protocol in order to (re)gain optimal motion after surgical release of the stiff elbow. TRIAL REGISTRATION The trial is registered at the Dutch Trial Register: NTR6067 , 31-8-2016.
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Affiliation(s)
- Jetske Viveen
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Flinders University, Bedford Park SA, Adelaide, 5042, Australia
| | - Izaak F Kodde
- Department of Orthopaedic Surgery, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam-Zuidoost, The Netherlands
| | - Pjotr Goossens
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Koen L M Koenraadt
- , Foundation for Orthopaedic Research, Care & Education, Amphia Hospital, 4818 , CK, Breda, The Netherlands
| | - Bertram The
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Denise Eygendaal
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands.,Department of Orthopaedic Surgery, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam-Zuidoost, The Netherlands
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Kodde IF, Kaas L, Flipsen M, Bekerom MPJVD, Eygendaal D. Current concepts in the management of radial head fractures. World J Orthop 2015; 6:954-960. [PMID: 26716091 PMCID: PMC4686442 DOI: 10.5312/wjo.v6.i11.954] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/22/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Fracture of the radial head is a common injury. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. As treatment strategies have changed over the years, with an increasing amount of literature on this subject, the purpose of this article was to provide an overview of current concepts of the management of radial head fractures.
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14
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Abstract
Radial head fractures are the most common fractures around the elbow. Because they are often accompanied by ligamentous injuries, we recommend considering them to be osteoligamentous injuries rather than simple fractures, even in undisplaced or minimally displaced fractures. Surgeons should always suspect and actively exclude concomitant ligament tears. The incidence of these associated injuries increases with greater severity of the radial head fracture. However, the standard Mason classification system does not adequately address this problem, and all attempts to establish a new classification system that provides concise treatment algorithms have failed. This article discusses the current treatment options and the current controversies in nonsurgical therapy, open reduction and internal fixation (ORIF) and radial head replacement.
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Affiliation(s)
- Klaus Josef Burkhart
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany.
| | - Kilian Wegmann
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Lars P Müller
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Frank E Gohlke
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany
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15
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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