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Helmstetter T, Maniglio M, Fornaciari P, Tannast M, Vial P. Open reduction and internal fixation of modified Mason type III/IV radial head fractures with more than three fragments: an analysis of the clinical outcome and reoperation rate. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1121-1130. [PMID: 37962633 PMCID: PMC10858131 DOI: 10.1007/s00590-023-03772-y] [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: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE It is generally accepted that a radial head fracture (RHF) with more than three parts is not suitable for repair; therefore, most authors suggest straightforward radial head arthroplasty (RHA). With up to 20% risk for reoperation after RHA, improvement in reduction and fixation techniques may represent a valuable alternative before further extending the indications for arthroplasty. To determine the functional results and radiological failure rate after osteosynthesis of multi-fragmentary RHF with more than three articular fragments. We specifically determined (1) the one-year Broberg and Morrey functional elbow score, (2) duration of fracture healing, (3) complication rate, and (4) number of patients converted to RHA. METHODS This study is a retrospective single-center case series. All patients who underwent primary osteosynthesis for RHF between 2012 and 2019 were included. Nine patients with an average age of 52 years had an average clinical and/or radiological follow-up of 49 months. RESULTS The preoperative imaging identified nine fractures with four fragments. Three patients underwent osteosynthesis with plates and screws, whereas six patients underwent osteosynthesis with only screws. The mean Broberg and Morrey score was 95 points. Overall, eight of the nine patients had satisfactory results. All patients retained their radial heads and showed radiological fracture healing. Only two patients presented with low-grade complications requiring no further surgery. CONCLUSION Our study showed that osteosynthesis of RHF with up to four fragments can achieve good functional results with a low complication rate and seems to be a valid alternative to RHA.
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Affiliation(s)
- Timothée Helmstetter
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland.
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland.
| | - Mauro Maniglio
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Paolo Fornaciari
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Moritz Tannast
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Philippe Vial
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
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Streck M, Vlček M, Veigl D, Pech J, Landor I. [Radial Head Replacement: Management of Elbow and Forearm Instability after Comminuted Radial Head Fractures Associated with Elbow Dislocation]. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:96-102. [PMID: 38801665 DOI: 10.55095/achot2024/012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE OF THE STUDY This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. KEY WORDS radial head, elbow, fracture, dislocation, resection, prosthesis.
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Affiliation(s)
- M Streck
- I. chirurgická klinika hrudní, břišní a úrazové chirurgie Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha
| | - M Vlček
- I. ortopedická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
| | - D Veigl
- I. ortopedická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
| | - J Pech
- I. ortopedická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
| | - I Landor
- I. chirurgická klinika hrudní, břišní a úrazové chirurgie Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha
- I. ortopedická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
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Romeo PV, Papalia AG, Alben MG, Halpern J, Ferati SR, Larose G, Singh H, Virk MS. 90-day outcomes and factors for complications following radial head arthroplasty for Mason Type III and IV radial head fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3099-3106. [PMID: 37029835 DOI: 10.1007/s00590-023-03532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The aim of this study is to evaluate 90-day outcomes and complications following radial head arthroplasty (RHA) for Mason Type III and IV radial head fractures (RHFs) and determine factors predisposing patients to early complications and revision surgery. METHODS Patients undergoing RHA for Mason Type III and IV RHFs were identified retrospectively from an institutional database. Postoperative complications, reoperations, elbow range of motion, radiographs and concomitant injuries on the ipsilateral upper extremity were reviewed. Additionally, injuries were sub-classified as low-energy trauma (LET) or high-energy trauma (HET). Univariate logistic regression was performed to evaluate the risk for complications using patient factors not limited to the presence of concomitant ligamentous or bony injuries. P values < 0.05 were considered statistically significant. RESULTS Seventy four patients were included in our study with an average follow-up time of 12.7 months. Complications within 90-days of operation occurred in 8.1% of patients: heterotopic ossification (4.1%), superficial wound dehiscence (2.7%), and posterior interosseous nerve palsy (1.4%). No patients required readmission or revision surgery in the 90-day postoperative period. Univariate regression analysis did not demonstrate a significant association between diabetes, ASA status, HET versus LET, or the presence of concomitant injury. Concomitant injuries were found in 92% of patients. CONCLUSION Radial head arthroplasty for RHFs demonstrates a low complication rate in the short-term. Diabetes, ASA class, high versus low energy trauma, and presence of concomitant injury were not found to be associated with higher complication rates in the 90-day postoperative period. LEVEL OF EVIDENCE Level of evidence IV, retrospective case series.
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Affiliation(s)
- Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Joshua Halpern
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Sehar Resad Ferati
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Gabriel Larose
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Hartej Singh
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20th Street, New York, NY, 10003, USA.
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Muacevic A, Adler JR, R P, Sondur S, Naik A, Gulia A, Mohanty A. Outcomes of the Posterior Approach for the Treatment of Radial Head Fractures and Associated Elbow Injuries: A Retrospective Observational Study. Cureus 2023; 15:e34041. [PMID: 36824544 PMCID: PMC9941026 DOI: 10.7759/cureus.34041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The lateral approach to the radial head remains the routinely used approach for surgical fixation or replacement despite the risk of injury to lateral soft tissue structures. Multiple approaches are required when dealing with complex elbow injuries involving other bony and soft tissue structures which lead to greater soft tissue dissection, prolonged immobilization, and a higher rate of elbow stiffness. This article utilizes a single posterior approach involving the Boyd interval in the surgical management of radial head fractures with an associated elbow injury. METHODS Thirteen patients with radial head fractures and related elbow injuries treated with the posterior approach to the elbow were retrospectively analyzed. All patients were operated on by a single surgeon and followed up for a minimum of 18 months postoperatively. Functional evaluation of the patients was performed at the final follow-up which comprised a range of movements of the elbow, visual analogue scale (VAS), Disability of Arm, Shoulder, and Hand (QuickDASH), and the Mayo Elbow Performance Score (MEPS). RESULTS The mean VAS score was 2.16, QuickDASH score, and Mayo elbow score were 7.15 ± 2.96 and 78.46 ± 8.26 respectively. The flexion-extension arc of the elbow was 128.46 ± 4.27 degrees and the supination-pronation arc was 133.92 ± 4.04 degrees at one-year follow-up. Two patients developed early postoperative complications (elbow stiffness and ulnar nerve neuropraxia) and recovered spontaneously. No patients developed neuropraxia of the posterior interosseous nerve (PIN). CONCLUSION The single incision posterior (Boyd) approach to the elbow offers complete access to the radial head, olecranon, coronoid, and lateral ligamentous structures in complex elbow injuries and provides good functional outcomes in our small observational study.
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Affiliation(s)
| | - John R Adler
- Orthopedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Adl Amini D, Thiele K, Hanlon J, Wu CH, Stöckle U, Bäcker HC, Dahne M. Percutaneous elevation of radial head fractures without fixation – a promising technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022. [DOI: 10.1016/j.xrrt.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Zhou X, Wang B, Liu Y, Wang Z, Zhao X, Liu F, Lu S, Xu W, Li L, Dong J. Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures. J Pain Res 2022; 15:3413-3422. [PMID: 36320225 PMCID: PMC9618242 DOI: 10.2147/jpr.s374599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method – a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws. Methods From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups. Conclusion The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Bingzhi Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yu Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Zicheng Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China,Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Lianxin Li, Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8613505312449, Email
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Jinlei Dong, Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Tel +861509874540, Email
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Mohanty K, Agarwal R. Trauma. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jia Z, Hong Y, Li C, Lin J, Hu X. The clinical efficacy of the minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails. Am J Transl Res 2021; 13:12807-12815. [PMID: 34956495 PMCID: PMC8661165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/24/2021] [Indexed: 06/14/2023]
Abstract
Radial head fractures (RHFs) occur most frequently among all elbow fractures. Current treatments pose several limitations for the Mason type II radial head fractures. This study was performed to evaluate the clinical efficacy of a new minimally invasive treatment for Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails. Between January 2018 and December 2019, our group used double titanium elastic intramedullary nails as a minimally invasive treatment for 32 cases of Mason II type radial head fractures. After the treatments, we summarized and conducted a retrospective analysis to evaluate the surgical operation itself, the quality of the fracture reductions, the fracture healing, and any complications. The Mayo elbow function scores (MEPS) and the visual analog scale (VAS) pain scores were used to evaluate the clinical efficacy of this approach. All the patients recovered from their surgeries without any complications. We followed all the cases for an average of 12 months. The elbow extension range of motion was 5 degrees (range: 0-15 degrees), the elbow flexion range of motion was 140 degrees (range: 135-146 degrees), and the average forearm pronation range of motion was 84.1 degrees (range: 78-90 degrees). The average forearm supination range of motion was 80.4 degrees (range: 75-85 degrees). All the fractures healed (a 100% healing rate), the MEPS score was 96.7 (range: 85-100), and the MEPS ratings of excellent and good were both 100%. The VAS pain scores ranged from 0-1. The minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double elastic nails proved to be a simple approach with a relatively short operation time. It required only a small incision with little trauma and had few complications, so it is worth consideration for wider use.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Yixia Hong
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Chuangli Li
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Jiandong Lin
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Xinjia Hu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
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Fiorentino G, Arduini M, D'Ambrosi R, Usuelli FG, Catellani F. Clinical and radiological outcomes of autologous humeral bone grafting for radial head reconstruction: a minimum 2-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1153-1161. [PMID: 34387722 DOI: 10.1007/s00590-021-03094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this prospective study was to assess the clinical and functional results of radial head reconstruction with an autologous bone graft from distal humerus in 12 patients, with a follow-up for a period of 24 months. METHODS From March 2017 to June 2018, we surgically treated 12 patients using an autologous bone graft from the lateral distal metaphysis of the homolateral humerus. Patients were divided into two groups: -Group A consisted of patients with previous failed ORIF for radial head fracture. Patients underwent revision surgery at an average time of 7 months (between 6 to 8 months) from the first surgery. All the patients reported pain during the elbow range of motion with no gross clinical signs or instability of the joint. They all presented standard X-ray and CT-scan of the elbow suggestive of non-union fracture. None of them presented osteoarthritic modification at the time of surgery. -Group B consisted of patients reporting acute irreparable radial head fractures. Patients were evaluated clinically at 6-, 12-, and 24-months duration according to Disabilities of the Arm. Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Visual analogue score for pain (VAS);, range of motion (ROM) was evaluated at 6 and 24 months after surgery. Plain radiographs on anteroposterior and lateral views of the elbow were evaluated at final follow-up. RESULTS In both, groups (A and B) patients showed a significant improvement with regards to VAS, MEPS, and DASH at each follow-up (p < 0.05). X-rays showed complete bone healing in all patients with no sign of mobilisation or loosening of the screws. One case in group A presented asymptomatic partial ossification of LUCL. No cases of fracture or residual pain at the donor site. Furthermore, no other complications such as infection, wound issues, elbow instability, elbow stiffness, ulnar neuritis, graft non-union were reported. CONCLUSIONS Distal humerus bone graft should be considered a reliable option for the treatment of acute fractures that are unrepairable fractures or revision surgery for failed ORIF of the radial head, especially among young patients where prosthesis may be reserved as a salvage procedure, and radial head resection is a damaging and is not considered desirable. LEVEL OF EVIDENCE Level IV - Prospective Case Series.
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Affiliation(s)
| | | | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy.
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Luenam S, Bantuchai T, Kosiyatrakul A, Chanpoo M, Phakdeewisetkul K, Puncreobutr C. Precision of computed tomography and cartilage-reproducing image reconstruction method in generating digital model for potential use in 3D printing of patient-specific radial head prosthesis: a human cadaver study. 3D Print Med 2021; 7:3. [PMID: 33507428 PMCID: PMC7842042 DOI: 10.1186/s41205-021-00093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background A prosthetic replacement is a standard treatment for an irreparable radial head fracture; however, the surface mismatch of the commercially available designs is concerned for the long-term cartilage wear. The patient-specific implant created from 3D printing technology could be favorable in replicating the normal anatomy and possibly reduce such sequela. Our study aimed to assess the precision of the computed tomography (CT) and cartilage-reproducing image reconstruction method (CIRM) in generating digital models for potentially use in manufacturing the patient-specific prosthesis from 3D printing. Methods Eight intact elbows (3 right and 5 left) from 7 formalin-embalmed cadavers (4 males and 3 females) with mean age of 83 years (range, 79–94 years) were used for this study. Computerized 3D models were generated from CT, and CIRM. The cartilage-reproducing image reconstruction method has compensated the cartilage profile based on the distance between the subchondral surfaces of the radial head and surrounding bones in CT images. The models of actual radial head geometry used as the gold standard was generated from CT arthrography (CTA). All models of each specimen were matched by registering the surface area of radial neck along with the tuberosity. The difference of head diameter, head thickness, and articular disc depth among three models was evaluated and analyzed by Friedman ANOVA and multiple comparison test using Bonferroni method for statistical correction. A p-value of less than 0.01 was considered statistically significant. The difference of overall 3D geometry was measured with the root mean square of adjacent point pairs. Results The analysis displayed the difference of diameter, thickness, and disc depth across the models (p< 0.01). Pairwise comparisons revealed statistically significant difference of all parameters between CTA models and CT models (p< 0.01) whereas no difference was found between CTA models and CIRM models. The mean difference of overall 3D geometry between CTA models and CT models was 0.51±0.24 mm, and between CTA models and CIRM models was 0.24±0.10 mm. Conclusions CIRM demonstrated encouraging results in reestablish the normal anatomy and could be potentially used in production process of 3D printed patient-specific radial head prosthesis.
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Affiliation(s)
- Suriya Luenam
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Bangkok, 10400, Thailand.
| | - Theeraset Bantuchai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Bangkok, 10400, Thailand
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Bangkok, 10400, Thailand
| | - Malee Chanpoo
- Department of Anatomy, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Chedtha Puncreobutr
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
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Xu GM, Liang ZY, Li W, Yang ZZ, Chen ZB, Zhang J. Finite Element Analysis of Insertion Angle of Absorbable Screws for the Fixation of Radial Head Fractures. Orthop Surg 2020; 12:1710-1717. [PMID: 33000562 PMCID: PMC7767780 DOI: 10.1111/os.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/04/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the biomechanical effects of different insertion angles of absorbable screws for the fixation of radial head fractures. Methods The finite element models used to simulate the fractures were created based on CT scans. Two absorbable screws were used to fix and maintain the stability of the fracture, and the angles between the screws were set to 0°, 15°, 30°, 45°, 60°, 75°, and 90°. A downward force of 100 N was applied at the stress point, which was coupled with the surface, and the distal radius was limited to six degrees of freedom. The direction and location of the applied force were the same in each model. The values of the von Mises stress and peak displacements were calculated. Results Under the applied load and different screw angles, the maximum von Mises stress in the screws was concentrated on the surface contacting the fracture surfaces. The maximum von Mises equivalent stress in the screw decreased when the angle increased from 0° (19.54 MPa) to 45° (13.11 MPa) and increased when the angle further increased to 90° (24.63 MPa). The peak displacement decreased as the angle increased from 0° (0.19 mm) to 45° (0.15 mm) and increased when the angle further increased to 90° (0.25 mm). Conclusion The computational stress distribution showed that fixation with absorbable screws is safe for patients. Moreover, the minimum von Mises stress and displacements were generated when the angle between the screws was 45°; hence, this setting should be recommended for Mason type II radial fractures.
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Affiliation(s)
- Guang-Ming Xu
- Department of Orthopaedics, Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zi-Yang Liang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Li
- Department of Orthopaedics, Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zheng-Zhong Yang
- Department of Orthopaedics, Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhi-Bin Chen
- Department of Orthopaedics, Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jie Zhang
- Department of Orthopaedics, Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, China
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