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Giannetti S, Smimmo A, Torre G, Stancati A, Pagano E, Santucci A. Percutaneous treatment of radial neck fractures in adult patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1413-1418. [PMID: 38227012 DOI: 10.1007/s00590-023-03811-8] [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: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. MATERIAL AND METHODS A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. RESULTS The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. CONCLUSIONS The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).
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Affiliation(s)
- Silvio Giannetti
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | | | - Guglielmo Torre
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Andrea Stancati
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Ernesto Pagano
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Attilio Santucci
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
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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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Perloff EM, Crijns TJ, O'Connor CM, Ring D, Marinello PG. Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography. Clin Shoulder Elb 2023; 26:156-161. [PMID: 37316176 DOI: 10.5397/cise.2022.01368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/14/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. METHODS One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. RESULTS Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." CONCLUSIONS The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.
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Affiliation(s)
- Eric M Perloff
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Tom J Crijns
- Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Casey M O'Connor
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - David Ring
- Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin, Austin, TX, USA
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Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology. J Shoulder Elbow Surg 2023; 32:463-474. [PMID: 36403925 DOI: 10.1016/j.jse.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The radial head is the forearm's pivot point for supination-pronation. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. METHODS In this study, 23 patients who had comminuted radial head fractures had personalized radial head prostheses inserted. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. The mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow range of motion, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were evaluated 2 years postoperatively. RESULTS QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. DISCUSSION Since personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomies were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results.
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Kastenberger T, Kaiser P, Spicher A, Stock K, Benedikt S, Schmidle G, Arora R. Clinical and radiological outcome of Mason-Johnston types III and IV radial head fractures treated by an on-table reconstruction. J Orthop Surg Res 2022; 17:503. [PMCID: PMC9675101 DOI: 10.1186/s13018-022-03394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Only few methods treating comminuted radial head fractures have been established providing sufficient joint reconstruction, restoring radial length and enabling early joint mobilization. When an anatomical reconstruction using open reduction and internal fixation is not possible, radial head resection or primary arthroplasty is often conducted. An “Ex situ/on-table” reconstruction is widely disregarded but can be an option. The purpose of this study was to evaluate the functional and radiological outcome of comminuted radial head fractures treated with an “on-table” reconstruction and internal fixation using a low profile plate. Methods Fourteen patients who sustained a radial head fracture (9 Mason-Johnston type III and 5 Mason-Johnston type IV) and were treated with an “on-table” reconstruction between 2010 and 2020 were evaluated retrospectively. The patients mean age was 41.3 years (range 21–69). The clinical evaluation included active range of motion, grip strength, pain level and elbow stability. The functional outcome was assessed using the Disability of Arm, Shoulder and the Hand (DASH) score, Mayo Elbow Performance Index (MEPI), Broberg and Morrey score. The radiological examination included a.p. and lateral views of the injured elbow to evaluate nonunions, loss of reduction, joint alignment, avascular radial head necrosis, heterotopic ossifications and posttraumatic osteoarthritis. Results The inclusion rate was 74% with a mean follow-up of 50 months (range 16–128). The mean elbow flexion of the injured side was 126° (range110–145°) with an average extension loss of 8° (range 0–40°). Pronation was 65° (15–90°) and supination 66° (5–90°). The mean MEPI was 87 points (range 45–100). The mean DASH score was 13 points (range 1–88). According to the Broberg and Morrey functional scoring system, the average score was 92 points (range 88–100). Complete bone union was achieved in 9 cases, partial union in 4 cases and nonunion in one case. There were no signs of avascular necrosis of the radial head. Signs of post-traumatic osteoarthritis were seen in 11 cases. Five patients needed an implant removal due to a radio-ulnar impingement and one patient a revision surgery due to the nonunion and implant breakage. Conclusions An on-table (ex situ) reconstruction of the radial head is a reliable option with a good clinical outcome and low complication rate in the surgical treatment of comminuted radial head fractures. It can restore joint alignment and maintain radial length. The risk for avascular necrosis is neglectable, and the bone healing rate is high.
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Affiliation(s)
- Tobias Kastenberger
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Peter Kaiser
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Anna Spicher
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Kerstin Stock
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Stefan Benedikt
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Ramazanian T, Müller-Lebschi JA, Merlet MCH, Lee H, Vaichinger AM, Fitzsimmons JS, O'Driscoll SW. Effect of Radiocapitellar Joint Over/Under Stuffing on Elbow Joint Contact Pressure. J Hand Surg Am 2022; 48:403.e1-403.e9. [PMID: 36229309 DOI: 10.1016/j.jhsa.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Comminuted radial head fractures are commonly treated by surgical resection or replacement with a prosthesis. A potential problem with radial head replacement is overlengthening of the radial neck ("overstuffing" of the radial head), which has been shown to affect both ulnohumeral kinematics and radiocapitellar pressures. We hypothesized that an overstuffed radial head prosthesis increases capitellar pressure and reduces coronoid pressure. METHODS Seven human cadaveric elbows were prepared on a custom-designed apparatus simulating stabilizing muscle loads, and passively flexed from 0° to 90° under gravity valgus torque while joint contact pressures were measured. Each elbow was tested sequentially with different neck lengths, starting with the intact specimen followed by insertion of understuffed (-2 mm), standard-height (0 mm), and overstuffed (+2 mm) radial head prostheses in neutral forearm rotation, 40° pronation, and 40° supination positions, respectively. RESULTS Capitellar mean contact pressures significantly increased after insertion of an overstuffed radial head prosthesis. In valgus position with neutral forearm rotation, capitellar mean contact pressure on the joint with an intact radial head averaged 227 ± 70 kPa. Insertion of understuffed, standard-height, and overstuffed radial head prostheses changed the mean contact pressures to 152 ± 76 kPa, 212 ± 68 kPa, and 491 ± 168 kPa, respectively. The overstuffed radial head group had significantly lower whole coronoid mean contact pressures (153 ± 56 kPa) compared with the intact (390 ± 138 kPa) and standard-height (376 ± 191 kPa) radial head groups. CONCLUSIONS An increase in radial prosthesis height significantly increases capitellar contact pressures and reduces coronoid contact pressures. CLINICAL RELEVANCE Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. Elevated capitellar contact pressures can potentially lead to pain and early degenerative changes.
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Affiliation(s)
- Taghi Ramazanian
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - HoMin Lee
- Department of Orthopedics, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Anthony M Vaichinger
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Hatta T, Shinagawa K, Kawakami J, Yamamoto N, Kitada M, Itoi E. Downsizing effect of a modular radial head prosthesis on the lateral collateral ligament of the elbow: A cadaveric study. Clin Biomech (Bristol, Avon) 2020; 80:105140. [PMID: 32745705 DOI: 10.1016/j.clinbiomech.2020.105140] [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: 05/09/2019] [Revised: 05/23/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unclear how the head and stem diameters for the radial head prosthesis could affect mechanical properties of the lateral collateral ligament measured by strain changes during elbow and forearm motions. METHODS Eight cadaveric specimens were secured to the device, which allows elbow flexion-extension and forearm pro-supination. Using six different implant combinations comprising 2 sizes for the head (long- and short-axis of the native head) and 3 sizes for the stem (press-fit, -1 mm, and -2 mm downsizing), prostheses were attached via the posterior approach. A differential variable reluctance transducer placed on the central portion of the radial collateral ligament were used for strain measurement with elbow flexion at 0°, 30°, 60°, and 90°. At each position, the strain patterns with the forearm in the neutral and 45° pro-supination positions were also assessed. FINDINGS Specimens implanted with long-axis head component showed greater increases in the ligament strain during elbow flexion than intact specimens or those implanted with short-axis head. Compared to press-fit stem, implants with downsizing to -1 mm approximated strain patterns during pro-supination with elbow extension to intact condition. INTERPRETATION Morphologic variation of the head and stem components in radial head prostheses led to altered strain patterns in the lateral collateral ligament during elbow and forearm motions. A short-axis head component can be used to prevent excessive strain changes after the prosthesis application. Downsizing of the stem component might be an option for approximating the biomechanics at the radiocapitellar joint during forearm rotation to the intact elbow.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masaaki Kitada
- Department of Stem Cell Biology and Histology, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Guo L, Li R, Yang X, Yu C, Gui F. Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: A retrospective study of 40 patients. Injury 2020; 51:2253-2258. [PMID: 32718754 DOI: 10.1016/j.injury.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation with metallic plates and screws are hard to achieve. Conventional techniques include radial head resection and arthroplasty. Both methods have inevitable complications. The purpose of this retrospective study is to prove the feasibility of treating unsalvageable radial head fractures with absorbable polylactide pins. METHODS A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic plates and screws. Patients receiving both modalities were followed-up for a mean of 24 months (standard deviation SD: 2.6). Radiographic analysis was conducted 2, 30, 60, and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score, and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test. RESULT By the time of last follow up, All fractures in both groups healed successfully. The duration (134 min SD:21 min to 131 min SD:19 min) and blood loss (121 ml SD: 25 ml to 124 ml SD: 27 ml) during surgery of polylactide pin and metallic implant group have no statistical differences. The MEPI score (91 SD:7 to 94 SD:9), the Broberg and Morrey score (93 SD:3 to 93 SD:5), the DASH outcome measures (4.5 SD: 3.0 to 3.7 SD: 3.5), the range of motion also shows no statistical differences. Complications were infrequent and did not cause disability in both groups. All patients were satisfied with the surgical outcomes. CONCLUSION Polylactide pins can feasibly treat severely comminuted radial head fractures, which usually are considered unreducible. This technique provides an optional treatment plan in addition to resection or arthroplasty, especially for young patients that refuse that form of treatment.
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Affiliation(s)
- Liang Guo
- Department of orthopedic, the University-town Hospital of Chongqing Medical University, China
| | - Ruifu Li
- Department of orthopedic, the University-town Hospital of Chongqing Medical University, China.
| | - Xuhui Yang
- Department of orthopedic, the University-town Hospital of Chongqing Medical University, China
| | - Chao Yu
- Department of orthopedic, the University-town Hospital of Chongqing Medical University, China
| | - Fei Gui
- Department of orthopedic, the University-town Hospital of Chongqing Medical University, China
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Monoblock polyethylene radial head prosthesis for the treatment of unreconstructable acute radial head fractures with a minimum 1-year follow-up: A retrospective case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Szmit J, King GJW, Johnson JA, Langohr GDG. The effect of stem fit on the radiocapitellar contact mechanics of a metallic axisymmetric radial head hemiarthroplasty: is loose fit better than rigidly fixed? J Shoulder Elbow Surg 2019; 28:2394-2399. [PMID: 31371158 DOI: 10.1016/j.jse.2019.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head hemiarthroplasty is commonly used to manage comminuted displaced fractures. Regarding implant fixation, current designs vary, with some prostheses aiming to achieve a tight "fixed" fit and others using a smooth stem with an over-reamed "loose" fit. The purpose of this study was to evaluate the effect of radial head hemiarthroplasty stem fit on radiocapitellar contact using a finite element model that simulated both fixed (size-for-size) and loose (1-, 2-, and 3-mm over-reamed) stem fits. It was hypothesized that a loose stem fit would improve radiocapitellar contact mechanics, with an increased contact area and decreased contact stress, by allowing the implant to find its "optimal" position with respect to the capitellum. METHODS Finite element models of the elbow were produced to compare the effects of stem fit on radiocapitellar contact of a metallic axisymmetric radial head implant. Radiocapitellar contact mechanics (contact area and maximum contact stress) were computed for 0°, 45°, 90°, and 135° of elbow flexion with the forearm in neutral rotation, pronation, and supination. RESULTS The data suggest that the loose smooth stem radial head implant may be functioning like a bipolar implant in optimizing radiocapitellar contact. Over-reaming of 3 mm produced a larger amount of stress concentration on the capitellum, suggesting there may be a limit to how loose a smooth stem implant should be implanted. CONCLUSIONS The loose 1 to 2 mm over-reamed stem provided optimal contact mechanics of the metallic axisymmetric radial head implant compared with the fixed stem.
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High Risk of Further Surgery After Radial Head Replacement for Unstable Fractures: Longer-term Outcomes at a Minimum Follow-up of 8 Years. Clin Orthop Relat Res 2019; 477:2531-2540. [PMID: 31389899 PMCID: PMC6903861 DOI: 10.1097/corr.0000000000000876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence for treating acute, unreconstructable radial head fractures in unstable elbows with radial head replacement predominantly consists of short- to mid-term follow-up studies with a heterogenous mix of implants and operative techniques. Data on longer-term patient-reported outcomes after radial head replacement is lacking. QUESTIONS/PURPOSES (1) What proportion of patients undergo revision or implant removal after radial head replacement? (2) At a minimum of 8 years follow-up, what are the patient-reported outcomes (QuickDASH, Oxford Elbow Score, and EuroQol-5D)? (3) What factors are associated with a superior long-term patient-reported outcome, according to the QuickDASH? METHODS Between September 1994 and September 2010, we surgically treated 157 patients for acute radial head fractures. We excluded patients where the radial head was excised (n = 21), internally fixed (n = 15), or replaced as a secondary procedure after failed internal fixation (n = 2). A total of 119 patients who underwent radial head replacement surgery for an acute unreconstructable fracture were included, with a mean age of 50 years (range 15 to 93 ± 19 years), and 53% of patients (63) were women. All but two implants were uncemented, loose-fitting, monopolar prostheses, of which 86% (102) were metallic and 14% (17) were silastic. Implants were only cemented if they appeared unstable within the proximal radius. Silastic implants were used in the earlier series and replaced by metallic implants starting in 2000. We reviewed electronic records to document postoperative complications and prosthesis revision and removal. A member of the local research team (THC, CDC) who was not previously involved in patient care contacted patients to confirm complications, reoperations and to obtain long-term patient-reported outcomes scores. Nineteen patients had died at the point of outcome score collection. Of the remaining 100 patients, 80 were contacted (67% of total cohort), at a median of 11 years (range 8 to 24 years) after injury. The primary outcome measure was the QuickDASH score. RESULTS Of 119 patients, 25% (30) underwent reoperation, with three patients undergoing revision and 27 patients undergoing prosthesis removal at a median of 7 months (range 0 to 125 months). Twenty-one of 30 procedures (70%) occurred within 1 year after implantation. Kaplan-Meier survivorship analysis demonstrated a cumulative implant survival rate of 71%. In the 80 patients contacted, the mean QuickDASH score was 13 ± 14, the mean Oxford Elbow Score was 43 ± 6, and the median EuroQol-5D score was 0.8 (-0.3 to 1.0). After controlling for covariates, we found that prothesis revision or removal (p = 0.466) and prosthesis type (p = 0.553) were not associated with patient-reported outcome, according to the QuickDASH. CONCLUSIONS The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation. Patients must be counselled regarding this risk of secondary intervention, of which the peak risk appears to be within 1 year after implantation. Despite this, patients report low disability according to the QuickDASH at a minimum follow-up of 8 years. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Singh AK, Jidge A, Ramteke U, Venkateswaran N, Rokade H, Mulje SM, Mukherjee S, Kotian A. Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study. Open Access Maced J Med Sci 2019; 7:1505-1508. [PMID: 31198463 PMCID: PMC6542393 DOI: 10.3889/oamjms.2019.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The treatment for these fractures depends upon age, type of injury and whether the physics is closed or not. AIM: Comparison between radial head excision versus radial head replacement based on mayo elbow scoring in comminuted radial head fractures. MATERIAL AND METHODS: We did a prospective comparative study comprising 32 patients between age 22-60 years with Mason type II/III radial head fractures at Sir J.J Group of Hospitals, Mumbai. The patients were randomised using the admission day of the week placing 17 patients in the arthroplasty group and 15 patients in the excision group. The patients were followed up for 18-24 months (average 20 months) postoperatively. Results were analysed by the Mayo’s elbow performance score at 6 months and 18 months and were statistically evaluated by unpaired t-test. RESULTS: At 6 months, radial head arthroplasty gave excellent results in 2 patients, good in 5 patients and fair in 8 patients. In excision, there were 5 patients with excellent results at 6 months, 7 with good results and 2 with fair results. At 18 months, of the 17 patients who had undergone head arthroplasty, 2 had excellent results, and the same number had poor results. 7 (46.7%) of the 15 cases who had undergone radial head excision had excellent results. Good results were obtained in 7 cases of each. There was 6 cases (35.3%) of radial head arthroplasty which fell into the fair group. As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 68.82 and 18.66 respectively & for excision, it was 85.66 and 10.66. At 18 months follow up, it was 75 and 14.89 for arthroplasty & 90.66 and 7.98 for excision. The difference between the results was statistically significant (p < 0.01). CONCLUSION: Our study shows that long and short-term results of radial head excision are better as compared to arthroplasty in comminuted radial head fractures based on mayo elbow scoring, particularly for dominant upper limbs.
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Affiliation(s)
- Ayush Kumar Singh
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Aswini Jidge
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Ujwal Ramteke
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Nivedhitha Venkateswaran
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Hemlata Rokade
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - S M Mulje
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Sunirmal Mukherjee
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
| | - Abhinandan Kotian
- Wrightington, Wigan and Leigh NHS Foundation Trust, Metropolitan Borough of Wigan, Greater Manchester, United Kingdom
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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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Mukka S, Sjöholm P, Perisynakis N, Wahlström P, Rahme H, Kadum B. Radial head arthroplasty for radial head fractures: a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years. Eur J Trauma Emerg Surg 2018; 46:565-572. [PMID: 30382314 DOI: 10.1007/s00068-018-1042-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical and radiographic outcomes of bipolar and monopolar radial head arthroplasty in treatment of radial head fracture at a mean follow-up of 6 years. METHODS A retrospective multicentre cohort study of 30 patients treated for unreconstructable radial head fractures. Patients were treated either with a cemented bipolar or an uncemented monopolar radial head arthroplasty. All patients included were evaluated with patient-rated outcome questionnaire, physical examination, and radiographic evaluation at a mean of 6 years (range, 2-12 years) postoperatively. RESULTS There was no statistical difference in QuickDASH between the bipolar or monopolar groups. The majority of patients had no to little pain during rest. Neither flexion nor extension of the injured arm was significantly affected by the type of prosthesis. None of the patients in the bipolar group had any secondary surgery at the time of follow-up. In the monopolar group, four patients required removal of the arthroplasty. Signs of ulnohumeral degenerative changes were seen in the majority of patients in both groups (55% in the monopolar group, 92% in the bipolar group). CONCLUSION In this retrospective cohort study comparing a bipolar and a monopolar radial head arthroplasty for treatment of radial head fractures, we found comparable functional outcome but more revision procedures in the monopolar group at a mean follow-up of 6 years.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pontus Sjöholm
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Nikolaos Perisynakis
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Per Wahlström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Hans Rahme
- Department of Orthopaedics, Elisabeth hospital, Uppsala, Sweden
| | - Bakir Kadum
- Department of Clinical and Experimental Medicine, Linköping university, Linköping, Sweden.
- Department of Orthopaedics, Ryhov hospital, Jönköping, Sweden.
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Chytas ID, Antonopoulos C, Cheva A, Givissis P. Capitellar erosion after radial head arthroplasty: A comparative biomechanical study of operated radial head fractures on cadaveric specimens. Orthop Traumatol Surg Res 2018; 104:853-857. [PMID: 29581069 DOI: 10.1016/j.otsr.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/10/2018] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND We asked whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA), common techniques used for the confrontation of displaced or comminuted radial head fractures, are correlated with cartilage wear of the capitulum. HYPOTHESIS We hypothesized that neither ORIF nor RHA are correlated with capitellar cartilage wear. MATERIAL AND METHODS On 5 cadaveric elbow specimens, osteotomies were employed to simulate radial head comminuted fractures followed with ORIF by Herbert screws. Radial heads were also excised from other 5 cadaveric elbow specimens and were replaced by metallic monopolar implants. Finally, 2 elbows were not operated and used as a control group. Custom-made rotary machines, working unstoppably, generated 700,000 pronation and supination forearm movements at a 110° arc of motion. The elbow joints were examined with pre- and postoperative magnetic resonance imaging (MRI) scans and the articular surfaces of the capitula were resected and sent for histopathology study. RESULTS In the 2 cadaveric elbows of the control group and the 4 elbows treated with ORIF, no cartilage damage was found. The fifth one displayed cartilage fissures, which were, classified according to International Cartilage Repair Society (ICRS) grading system as grade I cartilage damage. On the contrary, all 5 elbows treated with RHA sustained complete cartilage loss, exposure of the subchondral bone and were classified as ICRS grade IV cartilage damage. DISCUSSION Our study suggests that metallic monopolar RHA after a displaced or comminuted radial head fracture carries a high risk of rapidly evolving cartilage loss of the capitulum.
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Affiliation(s)
- I D Chytas
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece.
| | - C Antonopoulos
- School of Electrical and Computer Engineering of Aristotle University, 54124 Thessaloniki, Greece
| | - A Cheva
- Pathology Laboratory of "G. Papanikolaou" General Hospital, Exohi, 57010 Thessaloniki, Greece
| | - P Givissis
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece
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Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures. BMC Musculoskelet Disord 2018; 19:288. [PMID: 30111311 PMCID: PMC6094563 DOI: 10.1186/s12891-018-2214-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of bone graft for the radial head fractures has been previously described and occasionally used by other authors.This is the first paper, to my knowledge, dealing with the relevant issue about the importance that the use of an autologous bone graft can have on the radial head fractures. METHODS From July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internal fixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis. RESULTS The average follow-up duration was 31 months (range, 24-50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12-17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internal fixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80-100); the outcome was excellent (90-100 points) in 13 patients and good (75-89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture (p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes. CONCLUSION Although radial head fractures may not be amenable to internal fixation, our findings suggest that open reduction and internal fixation with an autogenous bone graft from the lateral epicondyle of the humerus provides satisfactory elbow function in patients with comminuted Mason type II radial head fractures.
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17
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Laumonerie P, Tibbo ME, Kerezoudis P, Gauci MO, Reina N, Bonnevialle N, Mansat P. Short to midterm outcomes of one hundred and seventy one MoPyC radial head prostheses: meta-analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:2403-2411. [PMID: 30062566 DOI: 10.1007/s00264-018-4070-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The MoPyC implant is an uncemented long-stemmed radial head prosthesis that obtains primary press-fit fixation via controlled expansion of the stem. Current literature regarding MoPyC implants appears promising; however, sample sizes in these studies are small. Our primary objective was to evaluate the short- to midterm clinical outcomes of a large sample of the MoPyC prostheses. The secondary objective was to determine the reasons for failure of the MoPyC devices. METHODS Four electronic databases were queried for literature published between January 2000 and March 2017. Articles describing clinical and radiographic outcomes as well as reasons for reoperation were included. A meta-analysis was performed to obtain range of motion, mean Mayo Elbow Performance score (MEPS), radiographic outcome, and reason for failure. RESULTS A total of five articles describing 171 patients (82 males) with MoPyC implants were included. Mean patient age and follow-up were 52 years (18-79) and 3.1 years (1-9), respectively. Midterm clinical results were good or excellent (MEPS > 74) in 157 patients. Overall complication rate was low (n = 22), while periprosthetic osteolysis was reported in 78 patients. Nineteen patients returned to the operating room, with implant revision being required in ten patients. The two primary reasons for failure were (intra-)prosthetic dislocation (n = 8) followed by stiffness (n = 7); no painful loosening was described. CONCLUSION Short- to midterm outcomes of MoPyC prostheses are satisfactory and complications associated are low. The use of stem auto-expansion as a mode of obtaining primary fixation in radial head arthroplasty appears to be an effective solution for reducing the risk of painful loosening.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Marc Olivier Gauci
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, 06001, Nice, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
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Radial Head Resection versus Arthroplasty in Unrepairable Comminuted Fractures Mason Type III and Type IV: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4020625. [PMID: 30112387 PMCID: PMC6077546 DOI: 10.1155/2018/4020625] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022]
Abstract
Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.
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Shukla DR, Sahu DC, Fitzsimmons JS, An KN, O'Driscoll SW. The effect of a radial neck notch on press-fit stem stability: a biomechanical study on 7 cadavers. J Shoulder Elbow Surg 2018; 27:523-529. [PMID: 29198812 DOI: 10.1016/j.jse.2017.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimal micromotion is necessary for osteointegration of cementless radial head prostheses. When radial head fractures extend longitudinally, where the neck cut for prosthetic replacement should be made is uncertain. We hypothesized that complete resection of the notched portion of a radial neck confers no advantage in initial stability compared with not resecting the defect and inserting the implant into a notched radial neck. MATERIALS AND METHODS The radii of 7 cadavers underwent radial head resection and implantation with a 25-mm-long press-fit radial head stem. Before implantation, a 5-mm-long notch that was less than 1-mm wide was made in the radial neck. After the stem-bone micromotion was recorded, the proximal 5 mm of radial neck, incorporating the entire notch, was cut away, the stem was inserted 5 mm further, and the resulting micromotion was recorded. RESULTS The mean micromotion measured in the presence of a cortical notch was 51 ± 6 µm. After the neck was circumferentially cut and the stem was advanced, the micromotion (46 ± 9 µm) was not statistically significantly different. DISCUSSION Initial stability of an adequately sized cementless stem in the presence of a 5-mm-long cortical notch was well within the threshold needed for bone ingrowth (<100 µm). In addition, there was no reduction of micromotion after the notch-containing portion of the radial neck was resected and the stem was advanced. Making a neck cut distal to a 5-mm-long, 1-mm-wide cortical notch does not confer added stability. Thus, surgeons can preserve bone stock and avoid an aggressive neck cut.
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Affiliation(s)
- Dave R Shukla
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dipit C Sahu
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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20
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Singh N, Pandey CR, John R, Singh R, Tamang B, Bhandari S. The effectiveness of a modified Metaizeau technique in fixation of adult radial neck fractures: a prospective study with a modification of the Broberg-Morrey classification. J Shoulder Elbow Surg 2018; 27:411-417. [PMID: 29224986 DOI: 10.1016/j.jse.2017.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of adult radial neck fractures is lower compared with its pediatric counterpart. The literature on adult radial neck fracture management is limited; also, there is a lack of a detailed fracture classification system. In our study, we are evaluating the modified Metaizeau technique for the treatment of adult radial neck fractures. We also describe a modification to the existing fracture classification proposed by Broberg and Morrey to make it more inclusive of different fracture patterns. MATERIALS AND METHODS This is a prospective case series in which we included all the patients who presented to us with adult radial neck fractures. We used a modified Metaizeau technique to treat these fractures. Postoperatively, patients were followed up for a minimum duration of 1 year with a visual analog scale score, the Mayo Elbow Performance Score, the Oxford Elbow Score, the Disabilities of the Arm, Shoulder, and Hand score, and a subjective satisfaction questionnaire. RESULTS We included a total of 7 patients who had completed follow-up of 1 year. Of the total 7 cases, 3 cases had an associated radial head fracture (undisplaced), and 1 had an associated radial shaft fracture (segmental pattern). Elastic nails were removed at 6 weeks, and all fractures united. The subjects returned to their preinjury activity levels by the end of 3 months and had excellent outcomes as measured by various outcome scores. CONCLUSION The modified Metaizeau technique for closed reduction and internal fixation of adult radial neck fractures is effective and simple and has no complications compared with other treatment methods. However, further studies with larger sample sizes are needed to arrive at a more meaningful conclusion.
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Affiliation(s)
- Nagmani Singh
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal.
| | - Chakra Raj Pandey
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - Rakesh John
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Singh
- Department of Physiotherapy and Rehabilitation, Grande International Hospital, Kathmandu, Nepal
| | - Bhupal Tamang
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - Sandeep Bhandari
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
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Treatment of Radial Head Fractures and Need for Revision Procedures at 1 and 2 Years. J Hand Surg Am 2018; 43:241-247. [PMID: 29169720 DOI: 10.1016/j.jhsa.2017.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/05/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Optimal treatment strategies for radial head fractures remain a subject of debate. We examined national practice patterns in the management of radial head fractures to determine rates of surgical treatment, type of surgery employed, and the incidence of reoperation. METHODS Between 2007 and 2011, we identified patients with radial head fractures along with their associated injuries by International Classification of Diseases, Ninth Revision codes in a national database of orthopedic insurance records. For those who underwent surgery, the type of intervention was identified and each patient was observed to determine whether a subsequent procedure was needed by 1 and 2 years. Chi-square analysis was performed to make comparisons between groups. RESULTS A total of 58,404 radial head fractures were identified between 2007 and 2011; of these, 2,981 underwent surgical treatment (5.1%). Rates of surgical intervention were significantly higher in the context of associated injuries. Among the 2,981 radial head fractures treated surgically, 57.1% underwent open reduction internal fixation (ORIF), 37.9% were treated with radial head arthroplasty, and 4.9% underwent radial head excision. When the surgically treated radial head fracture was associated with a coronoid fracture, elbow dislocation, or proximal ulna fracture, 64.2%, 54.3%, and 47.2% were treated with arthroplasty, respectively, compared with 32.6%, 41.9%, and 52.6% treated with ORIF, respectively. After initial surgical treatment, 12.7% and 14.4% of radial head fractures that underwent ORIF required a secondary surgery at 1 and 2 years, respectively, compared with 8.6% and 10.7% of radial head arthroplasties and 8.3% and 8.4% of resections. CONCLUSIONS Rates of arthroplasty were significantly higher in the context of associated injury, particularly in the setting of a coronoid fracture or elbow dislocation. Fractures initially treated with ORIF had a higher rate of revision surgery at both 1 and 2 years after the index procedure compared with arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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22
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Keil H, Schnetzke M, Kocharyan A, Vetter SY, Beisemann N, Swartman B, Grützner PA, Franke J. Long-term results after non-operative and operative treatment of radial neck fractures in adults. J Orthop Surg Res 2018; 13:28. [PMID: 29394909 PMCID: PMC5797341 DOI: 10.1186/s13018-018-0731-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to determine the functional long-term outcome after non-operative and operative treatment of radial neck fractures in adults. Methods Thirty-four consecutive patients with a mean age of 46.4 (18.0 to 63.0) years with a fracture of the radial neck who were treated between 2000 and 2014 were examined regarding the clinical and radiological outcome. Twenty patients were treated non-operatively, and 14 patients underwent surgery. Results After a mean follow-up of 5.7 (2.0 to 15.7) years, the clinical scores showed good results in both groups. The Disabilities of Arm, Shoulder and Hand score was 16.1 (0 to 71.6) in the non-operative group and 8.8 (0 to 50.8) in the operative group, respectively. The Mayo Elbow Performance Score was 80.0 (30 to 95) in the non-operative group and 82.5 (35 to 95) in the non-operative group, respectively. The initial angle of the radial head towards the shaft (RHSA) was significantly higher in the operative group in the anterior-posterior plane (12.8° [2 to 23] vs. 26.3° [1 to 90], p = 0.015). In the follow-up radiographs, the RHSA was significantly lower in the operative group (15.1° [3 to 30] vs. 10.9° [3 to 18], p = 0.043). Five patients developed 7 complications in the non-operative group, and 7 patients developed 12 complications in the operative group. Revision rates were higher in the operative groups as 1 patient received radial head resection in the non-operative (5%) group while 7 patients in the operative group (50%) needed revision surgery. Conclusion A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults. If needed due to major displacement, open reduction is associated with a higher risk of complications and the need for revision surgery but can achieve similar clinical results. Trial registration DRKS DRKS00012836 (retrospectively registered)
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Affiliation(s)
- Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Arpine Kocharyan
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sven Yves Vetter
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Paul-Alfred Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
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Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, Mansat P. The minimum follow-up required for radial head arthroplasty: a meta-analysis. Bone Joint J 2017; 99-B:1561-1570. [PMID: 29212677 DOI: 10.1302/0301-620x.99b12.bjj-2017-0543.r2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/11/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation. MATERIALS AND METHODS Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up. RESULTS A total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years. CONCLUSION The literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561-70.
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Affiliation(s)
- P Laumonerie
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - N Reina
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Kerezoudis
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - S Declaux
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - M E Tibbo
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - N Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Mansat
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
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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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Meena PK, Gaba S, Bobade S, Verma R, Borade A, Sonaje J, Chouhan A. Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study. Bull Emerg Trauma 2017. [PMID: 29177173 DOI: 10.18869/acadpub.beat.5.4.453.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. Methods A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. Results The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection group with mean extension lag of 15.7 ± 4.1 (p=0.022) and mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score of 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p<0.001), mean pronation of 59.2 ± 8.4 (p=0.003) and mean Broberg Morrey score of 81.9 ± 5 (p=0.031). Conclusion The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.
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Affiliation(s)
| | - Sahil Gaba
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Sandesh Bobade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Rajendra Verma
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Amrut Borade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Jayesh Sonaje
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Ankit Chouhan
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
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Meena PK, Gaba S, Bobade S, Verma R, Borade A, Sonaje J, Chouhan A. Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study. Bull Emerg Trauma 2017; 5:266-272. [PMID: 29177173 DOI: 10.18869/acadpub.beat.5.4.453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. Methods A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. Results The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection group with mean extension lag of 15.7 ± 4.1 (p=0.022) and mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score of 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p<0.001), mean pronation of 59.2 ± 8.4 (p=0.003) and mean Broberg Morrey score of 81.9 ± 5 (p=0.031). Conclusion The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.
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Affiliation(s)
| | - Sahil Gaba
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Sandesh Bobade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Rajendra Verma
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Amrut Borade
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Jayesh Sonaje
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
| | - Ankit Chouhan
- Department of Orthopedics, S.M.S. Hospital, Jaipur, India
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Laumonerie P, Reina N, Ancelin D, Delclaux S, Tibbo ME, Bonnevialle N, Mansat P. Mid-term outcomes of 77 modular radial head prostheses. Bone Joint J 2017; 99-B:1197-1203. [PMID: 28860400 DOI: 10.1302/0301-620x.99b9.bjj-2016-1043.r2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/03/2017] [Indexed: 11/05/2022]
Abstract
AIMS Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA. PATIENTS AND METHODS Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use. RESULTS The mean MEP and quickDASH scores were 90.2 (sd 14; 45 to 100), and 14.0 points (sd 12; 1.2 to 52.5), respectively. There were no significant differences between RHA performed in acute or delayed fashion. There were 30 re-operations (19 with, and 11 without removal of the implant) during the first three post-operative years. Painful loosening was the primary indication for removal in 14 patients. Short-stemmed prostheses (16 mm to 22 mm in length) were also associated with an increased risk of painful loosening (odds ratio 3.54 (1.02 to 12.2), p = 0.045). Radiocapitellar instability was the primary indication for re-operation with retention of the implant (5). The overall survival of the RHA, free from re-operation, was 60.8% (sd 5.7%) at ten years. CONCLUSION Bipolar and press-fit RHA gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae. The outcome may vary according to the design of the implant. The rate of re-operation during the first three years is predictive of the long-term survival in tight-fitting RHAs. Cite this article: Bone Joint J 2017;99-B1197-1203.
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Affiliation(s)
- P Laumonerie
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Reina
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - D Ancelin
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - S Delclaux
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - M E Tibbo
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Bonnevialle
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - P Mansat
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
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Abstract
Background/purpose Radial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses. Materials Between June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6–104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan’s lateral access and Kocher’s anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements. Results At the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion–extension and 159° of pronosupination. Personal satisfaction was good–excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic. Conclusions The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.
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Causes for early and late surgical re-intervention after radial head arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:1435-1443. [DOI: 10.1007/s00264-017-3496-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 04/21/2017] [Indexed: 11/25/2022]
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Hodax JD, Blood TD, Kleinhenz DT, Gorman M, DaSilva M, DaSilva M. An Anatomic Evaluation of Arthroscopic Access to the Radial Head. Arthroscopy 2017; 33:953-958. [PMID: 28343808 PMCID: PMC6139673 DOI: 10.1016/j.arthro.2017.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the area of the radial head accessible for visualization and screw placement from the standard anteromedial and anterolateral portals used in elbow arthroscopy. METHODS Five cadaveric elbows were arthroscopically evaluated using standard anteromedial and anterolateral portals. Markers (pins) were placed into the accessible portions of the radial head at maximal pronation and supination. Specimens were then evaluated by computed tomography, and the arc of the radial head accessible from each portal was determined. RESULTS A continuous 220.04° ± 37.58° arc of the radial head was accessible from the combination of the anterolateral and anteromedial portals. From the anteromedial portal, the arc obtained measured 147.96° ± 21.81°, and from the anterolateral portal, the arc obtained measured 156.02° ± 33.32°. Using the radial styloid as a marker for 0°, the mean total arc ranged from 92.3° ± 34.06° dorsal to 127.74° ± 23.65° volar relative to the radial styloid. CONCLUSIONS Standard anteromedial and anterolateral portals used for elbow arthroscopy allow access to an average 220° area of the radial head. CLINICAL RELEVANCE This study defines the area of the radial head that can be contacted using commonly used, safe, and simple portals.
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Affiliation(s)
- Jonathan D. Hodax
- Department of Orthopaedics, Warren Alpert School of Medicine, Brown University
| | - Travis D. Blood
- Department of Orthopaedics, Warren Alpert School of Medicine, Brown University
| | | | - Megan Gorman
- Warren Alpert School of Medicine, Brown University
| | - Manuel DaSilva
- Department of Orthopaedics, Warren Alpert School of Medicine, Brown University
| | - Manuel DaSilva
- Department of Orthopaedics, Warren Alpert School of Medicine, Brown University, U.S.A
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Akman YE, Sukur E, Circi E, Ozyalvac ON, Ozyer F, Ozturkmen Y. A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:118-122. [PMID: 28065478 PMCID: PMC6197420 DOI: 10.1016/j.aott.2016.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/24/2016] [Accepted: 03/21/2016] [Indexed: 12/02/2022]
Abstract
Objective The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. Methods Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. Results The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. Conclusion With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. Level of evidence Level III, Therapeutic study.
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Affiliation(s)
- Yunus Emre Akman
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Erhan Sukur
- Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Esra Circi
- Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Osman Nuri Ozyalvac
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Abstract
Radial head fractures are common injuries and are accompanied by clinically relevant associated injuries in over one-third of patients. They are commonly classified by the Mason classification or one of its modifications. Type I fractures are treated conservatively with early mobilization. Type II fractures can be treated conservatively or by open reduction and internal fixation (ORIF), depending on fragment size and dislocation. Bony restriction in forearm rotation is an indication for surgical treatment. Type III fractures are treated surgically, by means of ORIF, prosthetic replacement or excision. Comminuted fractures with more than three fragments are regarded as unsuitable for ORIF. However, optimal treatment of type II and III fractures is still the subject of debate and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures.
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Affiliation(s)
- Laurens Kaas
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - C. Niekvan Dijk
- Hand and Upper Limb Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Is radial head resection the first choice treatment of comminuted radial head fractures without associated instability? Injury 2017; 48:560-562. [PMID: 28069142 DOI: 10.1016/j.injury.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/01/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedics, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands.
| | - Denise Eygendaal
- Department of Orthopaedics, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands; Department of Orthopaedics, Amphia Hospital, Breda, 4819 EV, The Netherlands
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Lópiz Y, González A, García-Fernández C, García-Coiradas J, Marco F. Comminuted fractures of the radial head: resection or prosthesis? Injury 2016; 47 Suppl 3:S29-S34. [PMID: 27692103 DOI: 10.1016/s0020-1383(16)30603-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION At present, surgical treatment of comminuted radial head fractures without associated instability continues to be controversial. When anatomical reconstruction is not possible, radial head excision is performed. However, the appearance of long-term complications with this technique, along with the development of new radial head implants situates arthroplasty as a promising surgical alternative. The purpose of the present study was to compare the mid-term functional outcomes of both techniques. MATERIALS AND METHODS A retrospective study was performed between 2002 and 2011 on 25 Mason type-III fractures, 11 patients treated with primary radial head resection and 14 who received treatment of the fracture with metal prosthesis. At the end of follow-up, patients were contacted and outcomes evaluated according to: Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand score (DASH) and strength measurement. Radiographic assessment (proximal migration of the radius, osteoarthritic changes, and signs of prosthesis loosening) was also performed. RESULTS The average age of the sample was 53.7 years in the resection group, and 54.4 years in the replacement group, with a mean follow-up of 60.3 and 42 months respectively. According to the MEPS scale, there were 6 excellent cases, 3 good and 2 acceptable in the resection group, and 6 excellent cases, 3 good, 3 acceptable, and 2 poor in the prosthesis group. The mean DASH score were 13.5, and 24.8 for the resection and the replacement group respectively. We found one postoperative complication in the resection group (stiffness and valgus instability) and 6 in the replacement group: 3 of joint stiffness, 1 case of prosthesis breakage, and 2 neurological injuries. CONCLUSIONS Although this is a retrospective study, the high complication rate occurring after radial head replacement in comparison with radial head resection, as well as good functional results obtained with this last technique, leads us to recommend it for comminuted radial head fractures without associated instability.
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Affiliation(s)
- Yaiza Lópiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain.
| | - Ana González
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Javier García-Coiradas
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain
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Bigazzi P, Biondi M, Ceruso M. Radiocapitellar prosthetic arthroplasty in traumatic and post-traumatic complex lesions of the elbow. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:851-858. [PMID: 27544680 DOI: 10.1007/s00590-016-1837-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
Radiocapitellar prosthetic arthroplasty is a fascinating new option in the treatment of complex lesions of the elbow. The device has been developed in order to treat primitive and post-traumatic radiocapitellar degenerative arthritis, while preserving the ulnohumeral joint of the elbow. Compared to a radial head resection, it avoids valgus and axial instability of the elbow and forearm preventing ulnohumeral degeneration. Seven patients have been reviewed with a mean of follow-up of 40 months. Two of them presented with an acute trauma and five of them with a post-traumatic degenerative arthritis involving the radial compartment of the elbow. The patients' evaluation was performed using DASH and Mayo elbow performance score (MEPS). Implant overstuffing, loosening and degenerative changes of the ulnohumeral joint have been monitored with X-ray controls. All patients presented with a marked improvement in elbow function, no signs of overstuffing or ulnohumeral degeneration were observed. Two patients developed a clinically asymptomatic aseptic loosening of the radial press-fit stem. The radiocapitellar prosthetic arthroplasty shows convincing results in the treatment of symptomatic radiocapitellar degenerative arthritis. It has also been effective in acute trauma scenarios in the presence of major osteoarticular wearing or loss of the entire radiocapitellar joint.
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Affiliation(s)
- Prospero Bigazzi
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Marco Biondi
- Orthopaedic Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimo Ceruso
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Bowman SH, Barfield WR, Slone HS, Shealy GJ, Walton ZJ. The clinical implications of heterotopic ossification in patients treated with radial head replacement for trauma: A case series and review of the literature. J Orthop 2016; 13:272-7. [PMID: 27408502 DOI: 10.1016/j.jor.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/11/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022] Open
Abstract
Radial head arthroplasty (RHA) is an acceptable treatment for comminuted radial head fractures (RHF). Fourteen patients with no postop HO prophylaxis were treated with RHA for comminuted RHF. A 50% incidence in HO was seen following RHA with a statistically increased risk (p ≤ 0.05) of reoperation compared to those without HO. Decreased ROM was seen on the affected side (p ≤ 0.05); patients without HO showed no statistical difference (p ≥ 0.05) in ROM or grip strength. HO following RHA increases patient risk for reoperation and decreases ROM. We recommend HO prophylaxis with NSAIDs and/or radiotherapy if no direct patient contraindications are found.
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Affiliation(s)
- Seth H Bowman
- Medical University of South Carolina, Charleston, SC, United States
| | | | - Harris S Slone
- Medical University of South Carolina, Charleston, SC, United States
| | - Gerald J Shealy
- Medical University of South Carolina, Charleston, SC, United States
| | - Zeke J Walton
- Medical University of South Carolina, Charleston, SC, United States
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Gauci MO, Winter M, Dumontier C, Bronsard N, Allieu Y. Clinical and radiologic outcomes of pyrocarbon radial head prosthesis: midterm results. J Shoulder Elbow Surg 2016; 25:98-104. [PMID: 26687473 DOI: 10.1016/j.jse.2015.08.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/12/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The modular pyrocarbon (MoPyC) radial head prosthesis (Tornier, Saint-Ismier, France) is a monoblock modular radial head prosthesis. This study assessed midterm outcomes after implantation of the prosthesis. MATERIALS A retrospective study was conducted of a consecutive cohort of 65 patients who underwent radial head replacement with the MoPyC prosthesis from January 2006 to April 2013. Indications were fractures, early or late failures from orthopedic or fixation treatments, and revisions after another implant. Patients were observed for >2 years for range of motion, pain, and stability; function by the Mayo Elbow Performance Score (total score, 100) and grip strength were assessed. Quality of stem implantation, bone resorption around the neck, and periprosthetic lucency were noted and quantified on radiographs. Capitellum shape and density as well as humeroulnar aspect (river delta sign) were evaluated. Complications and revision procedures were noted. RESULTS We evaluated 52 of 65 patients (mean follow-up, 46 ± 20 months; range, 24-108). The Mayo Elbow Performance Score was 96 ± 7; pain score, 42 ± 7/45; and motion score, 18 ± 2/20. Function and stability were excellent. Radiology revealed 92% of patients with cortical resorption around the neck without mechanical failure. Bone resorption was mostly anterior and lateral; it resolved within the first year and thereafter was stable. Eight patients underwent revision surgery for stiffness. No implant failures were noted. CONCLUSION Results of the MoPyC radial head prosthesis appear to be satisfactory. Bone resorption around the neck (stress shielding) is frequent and stable after 1 year and does not impair stem fixation. The MoPyC prosthesis appears to be a reliable solution for replacing the radial head.
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Affiliation(s)
- Marc-Olivier Gauci
- Department of Orthopaedics and Sports Traumatology, Hôpital de l'Archet 2, Université de Nice-Sophia-Antipolis (UNSA), Nice, France
| | - Matthias Winter
- Department of Orthopaedics, Clinique Saint Jean, Cagnes-sur-Mer, France.
| | - Christian Dumontier
- Department of Reconstructive and Hand Surgery, Hôpital Saint Roch, Université de Nice-Sophia-Antipolis (UNSA), Nice, France
| | - Nicolas Bronsard
- Department of Orthopaedics and Sports Traumatology, Hôpital de l'Archet 2, Université de Nice-Sophia-Antipolis (UNSA), Nice, France
| | - Yves Allieu
- Department of Hand Surgery, Clinique Clémentville, Montpellier, France
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Solarino G, Vicenti G, Abate A, Carrozzo M, Picca G, Moretti B. Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection? Aging Clin Exp Res 2015. [PMID: 26215317 DOI: 10.1007/s40520-015-0425-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old. METHODS We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH--Disabilities of the Arm, Shoulder and Hand; MEPS--Mayo Elbow Performance Score, VAS--Visual Analog Scale) and plain films. RESULTS The mean follow-up was 40 months (range 24-72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3-45.8) and mean MEPS was 79 (range 65-97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability. DISCUSSION Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples. CONCLUSION Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.
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Affiliation(s)
- Giuseppe Solarino
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
| | - Antonella Abate
- Orthopaedic and Trauma Department, University of Foggia, Foggia, Italy
| | - Massimiliano Carrozzo
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Girolamo Picca
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
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Wang ML, Beredjiklian PK. Management of radial head fracture with elbow dislocation. J Hand Surg Am 2015; 40:813-6. [PMID: 25499845 DOI: 10.1016/j.jhsa.2014.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Mark L Wang
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
| | - Pedro K Beredjiklian
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Miller MC, Kuxhaus L, Cowgill ML, Cook HA, Druschel M, Palmer B, Baratz ME. Unique model evokes the supination/pronation deficits found after Mason II fractures. J Orthop Res 2015; 33:343-8. [PMID: 25565571 DOI: 10.1002/jor.22771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 10/20/2014] [Indexed: 02/04/2023]
Abstract
A rapid prototyping model of Mason II fracture was used to investigate baseline recommendations for surgical intervention founded on kinematic forearm rotational blockage. Exact replicas of the radial heads in nine cadaveric specimens were produced and specimens were tested in a physiologic elbow simulator. After testing supination/pronation, the rotations were repeated with native replicas and with replicas modeling 3 mm depressed Mason II fractures with and without a gap of 1 mm between the body and fragment. The fragments were located circumferentially around the radial head at 10, 2 and 6 o'clock positions. There was no statistical difference between the range of motion of the native case and the native replica without fracture. After inclusion of the fracture, seven of the nine specimens showed rotational blockages. A two-way ANOVA found no statistical difference due to type of Mason II fracture (p > 0.87) or fracture location (p > 0.27). A χ-square analysis showed that presence of a kinematic deficit with a fractured radial head was significant (p < 0.03). The results support continued surgical intervention for a 3 mm depressed fracture and also establish the use of the rapid prototype as a model for kinematic investigation of fractures in a cadaveric model when ligamentous attachments are preserved.
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Affiliation(s)
- Mark Carl Miller
- Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
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Cohn M, Glait SA, Sapienza A, Kwon YW. Radiocapitellar joint contact pressures following radial head arthroplasty. J Hand Surg Am 2014; 39:1566-71. [PMID: 24997784 DOI: 10.1016/j.jhsa.2014.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the radial head arthroplasty length that best replicates the native radiocapitellar contact pressure. METHODS Eight cadaveric elbows (4 matched pairs) with an average age of 73 years were tested. All specimens were ligamentously stable and without visible cartilage wear. Radiocapitellar contact pressures were digitally analyzed during simulated joint loading at 0°, 45°, and 90° of elbow flexion and neutral rotation in the intact specimens and after ligament-preserving radial head arthroplasty at -2 mm, 0 mm, and +2 mm of the native length. The results were analyzed using 1-way analysis of variance and post hoc Tukey pairwise comparison tests. RESULTS Paired analysis demonstrated significantly decreased mean contact pressures when comparing the native versus the minus 2 groups. Significantly decreased maximum contact pressures were also noted between the native and the minus 2 groups. Examining the mean contact pressures showed no significant difference between the native and the zero group and the native and the plus 2 groups. As for the maximum contact pressures, there was also no significant difference between the native and the zero group and the native and the plus 2 group. CONCLUSIONS Up to 2 mm of overlengthening may be tolerated under simulated loading conditions without significantly increasing contact pressures of the radiocapitellar joint. Surgeons can use this knowledge along with radiographic parameters and intraoperative examination of elbow stability to gauge the appropriate size of the radial head implant to be used in order to decrease the risk of overstuffing the joint and minimizing radiocapitellar chondral wear. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Michael Cohn
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Sergio A Glait
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
| | - Anthony Sapienza
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Young W Kwon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop Relat Res 2014; 472:2136-43. [PMID: 24549774 PMCID: PMC4048424 DOI: 10.1007/s11999-014-3516-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND When treating complex radial head fractures, important goals include prevention of elbow or forearm instability, with restoration of radiocapitellar contact essential. When open reduction and internal fixation cannot achieve this, radial head replacement is routinely employed, but the frequency of and risk factors for prosthesis revision or removal are not well defined. QUESTIONS/PURPOSES We determined (1) the frequency of prosthesis revision or removal after radial head replacement for acute complex unstable radial head fractures, (2) risk factors for revision or removal, and (3) functional outcomes after radial head replacement. METHODS We identified from our prospective trauma database all patients over a 16-year period managed acutely for unstable complex radial head fractures with primary radial head replacement. Of the 119 patients identified, 105 (88%) met our inclusion criteria; mean age was 50 years (range, 16-93 years) and 57 (54%) were female. All implants were uncemented monopolar prostheses, of which 86% were metallic and 14% silastic. We recorded further procedures for prosthesis revision or removal for any cause, with a minimum followup of 1 year (n = 105). Cox regression analysis was used to determine independent factors associated with revision or removal when controlling for baseline patient (age, sex, comorbidities) and fracture (location, classification, associated injury) characteristics. Short-term functional outcomes (Broberg and Morrey score, ROM) were determined from retrospective review of clinic followup (n = 74), with a minimum followup of 3 months. RESULTS Twenty-nine patients (28%) underwent prosthesis revision (n = 3) or removal (n = 26) at a mean of 6.7 years (range, 1.8-18 years) after injury. Independent risk factors for removal or revision were silastic implant type and lower age. At a mean of 1.1 years (range, 0.3-5.5 years) after surgery, mean Broberg and Morrey score was 80 out of 100 (range, 40-99). Mean elbow flexion was 133° (range, 90°-159°; SD, 13°), extension 21° (range, 0°-80°; SD, 17°), flexion arc 112° (range, 10°-140°; SD, 25°), pronation 84° (range, 0°-90°; SD, 18°), supination 73° (range, 0°-90°; SD, 28°), and forearm rotation arc 156° (range, 0°-180°; SD, 38°). CONCLUSIONS We demonstrated a high removal or revision rate after radial head replacement for acute unstable complex fractures, with lower age and silastic implants independent risk factors. Younger patients should be counseled regarding the increased risk of requiring further surgery after radial head replacement. Future work should focus on long-term patient-reported outcomes after these injuries. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Daniels CJ, Gliedt JA, Enix DE. Radial neck fracture presenting to a Chiropractic clinic: a case report and literature review. Chiropr Man Therap 2014; 22:14. [PMID: 24685056 PMCID: PMC3994219 DOI: 10.1186/2045-709x-22-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/24/2014] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury. Clinical features A 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. The complaint originated three weeks prior following a fall on her left elbow while hiking. Intervention and outcome Plain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement--classified as a Mason Type II fracture. The patient was referred for medical follow-up with an orthopedist. Conclusion This report discusses triage of an elbow fracture presenting to a chiropractic clinic. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management.
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Abstract
The outcome of prosthetic elbow surgery is continually evolving. We thoroughly reviewed the literature on this issue to analyse the indications, outcomes and complications of the numerous types of implants currently in use. Radial head replacement is recommended in comminuted fractures of the radial head and in post-traumatic conditions. Medium- and long-term results prove to be satisfactory in the majority of cases, with no evidence to indicate that some prostheses (monopolar vs. bipolar; cemented vs. press-fit) are more effective than others; nonetheless, the bipolar-cemented implant was found to be associated with a lower revision rate than other prostheses. Unicompartmental arthroplasty has recently been used for the treatment of osteoarthritis and rheumatoid arthritis when the lateral compartment is prevalently involved; the results reported to date have been encouraging, although further studies are warranted to confirm the validity of these implants. Total elbow arthroplasty is performed in a range of conditions, including distal humerus fractures in the elderly and elbow arthritis. In the former condition, linked elbow replacement yields excellent results with few complications and a low revision rate. In elbow arthritis, total elbow arthroplasty is indicated when patients suffer from disabling pain, stiffness and/or instability that prevent them from performing daily activities. Unlinked elbow arthroplasty, which is used above all in rheumatoid arthritis, also yields satisfactory results, although the risk of instability persists. The use of linked elbow arthroplasty, which yields similar results but lower revision rates, has consequently increased. Lastly, the results yielded by linked elbow prosthesis in post-traumatic conditions are good, although not quite as good as those obtained in rheumatoid arthritis. Early mechanical failure may occur in younger and more active patients after elbow arthroplasty. However, the careful selection of patients who are prepared to accept functional limitations imposed by elbow implants will enable indications for elbow arthroplasty to be extended to young subjects, particularly when no other therapeutic options are available.
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Loeffler BJ, Green JB, Zelouf DS. Forearm instability. J Hand Surg Am 2014; 39:156-67. [PMID: 24315636 DOI: 10.1016/j.jhsa.2013.07.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/23/2013] [Accepted: 07/10/2013] [Indexed: 02/02/2023]
Abstract
Forearm instability results from trauma, which disrupts the radial head, the interosseous membrane, and the triangular fibrocartilage complex. Inadequate treatment of injuries to these forearm stabilizers may result in the complex problem of chronic longitudinal forearm instability. Delayed recognition and/or treatment of injuries producing forearm dissociation has led to poor patient outcomes, which makes timely recognition of the injury pattern imperative. This article discusses relevant aspects of forearm anatomy and current concepts in the diagnosis and treatment options for this complex injury pattern.
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Affiliation(s)
| | | | - David S Zelouf
- Philadelphia Hand Center, King of Prussia, Pennsylvania.
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Yalcinkaya M, Bagatur AE, Erdogan S, Zorer G. Resection arthroplasty for Mason type III radial head fractures yield good clinical but poor radiological results in the long term. Orthopedics 2013; 36:e1358-64. [PMID: 24200438 DOI: 10.3928/01477447-20131021-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Long-term clinical and radiographic outcomes of primary resection for Mason type III radial head fractures were evaluated in 13 patients (14 elbows) with a mean age of 38.8 years (range, 20-67 years) at the time of surgery. All patients had isolated radial head fractures without associated injuries. Mean follow-up was 14.7 years (range, 9-26 years). Proximal migration of the radius and the carrying angle were measured, and radiographs were reviewed for degenerative elbow and wrist arthritis and periarticular ossification. Five results were excellent and 9 were good. In 8 cases, the radii had migrated proximally and the carrying angle had increased an average 6.3°; the increases in both ulnar variance and the carrying angle were significant, and a significant negative correlation was found between the carrying angles and the clinical scores. Degenerative changes occurred in 8 elbows and 4 wrists, and periarticular heterotopic ossification was present in 3 elbows. Despite the satisfactory long-term outcomes, radial head resection resulted in proximal migration of the radius and an increase in the carrying angle; in addition, osteoarthritic changes in both elbows and wrists as well as periarticular heterotopic ossification were frequent findings without pronounced functional impairment.
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Fowler JR, Goitz RJ. Radial head fractures: indications and outcomes for radial head arthroplasty. Orthop Clin North Am 2013; 44:425-31, x. [PMID: 23827844 DOI: 10.1016/j.ocl.2013.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Radial head fractures without associated bony or ligamentous injury can be safely treated with internal fixation, if possible, or arthroplasty if nonreconstructable. However, nonreconstructable radial head fractures in association with elbow dislocation and/or ligamentous injury in the elbow or forearm represent a specific subset of injuries that requires restoration of the radiocapitellar articulation for optimal function. The purpose of this article was to summarize the indications for radial head arthroplasty and discuss the reported outcomes.
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Affiliation(s)
- John R Fowler
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Dudda M, Fehmer T, Schildhauer TA, Kruppa C. The Posttraumatic Proximal Cross-union of the Forearm in Childhood: What is Recommended? Orthop Rev (Pavia) 2013; 5:72-6. [PMID: 23888205 PMCID: PMC3718239 DOI: 10.4081/or.2013.e15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/30/2023] Open
Abstract
The posttraumatic proximal cross-union of the forearm in childhood is a rare complication after radial head, neck or proximal forearm fractures and elbow dislocations. There is no standardized treatment. Several surgical procedures with or without interposition techniques are described in the literature. The aim of this study was to analyze all children with cross-unions who underwent surgery over the last 15 years. From 1998 to 2013, 8 children with a posttraumatic proximal cross-union of the forearm (Type 3 according to Vince and Miller) received surgical treatment with resection of the cross-union or radial head. Mean age at the time of initial trauma was 9.0±2.56 years (range 6-14 years), age at the time of surgery was 11.9±3.09 years (range 7-16 years). Mean time of resection of the crossunion was 23.2 months. Follow-up time was 10.6 months (range 1-36 months). Five patients had a resection of the cross-union without any interposition techniques, in 2 cases with an additional arthrolysis of the elbow. One patient had an interposition of a local fascia flap. In 2 cases, a primary excision of the radial head, six and seven years, respectively, after trauma, was performed. All patients, except one, had non-steroidal antiinflammatory drugs therapy after surgery. A post-operative irradiation was performed in 3 cases. The mean postoperative range of motion for pronation/supination was 36/0/53°. Controversy remains about the best procedure to adopt for posttraumatic cross-union in childhood. After analysis of our data and the literature, we recommend the resection of the crossunion within 6-24 months of occurrence without necessarily using any interposition techniques. All patients reported an improvement with regard to ordinary activities. In cases of long-term cross-union for several years with ankylosis of the elbow and bony deformities of the proximal radius, an excision of the radial head as salvage procedure is recommended.
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Affiliation(s)
- Marcel Dudda
- Department of Surgery, University Hospital Bergmannsheil, Ruhr-University of Bochum, Germany
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Abstract
Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred. This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence.
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Affiliation(s)
- A D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Abstract
OBJECTIVE The purpose of this study is to provide a radiographic outcome assessment of radial head arthroplasty in correlation with clinical outcomes and to determine whether there is an association between certain patient factors and clinical and radiographic outcomes. MATERIALS AND METHODS A 10-year retrospective review was performed to identify patients with metal radial head arthroplasty. At least two follow-up radiographs were reviewed for each patient and were correlated with clinical information. Statistical analysis included calculation of complication rates, phi coefficient for variable association with complications, and Kaplan-Meier survival. RESULTS A total of 258 radial head implants in 244 patients were reviewed. The mean patient age was 46 years, with mean follow-up time of 12.8 months. Two hundred nineteen (84.9%) implants were unipolar in design, whereas 39 implants were bipolar. The most common indication for arthroplasty was trauma (94% acute and 2% failed internal fixation). Radiographic abnormalities included nonbridging heterotopic ossification (38.0%), secondary radiocapitellar joint osteoarthritis (27.9%), loosening (19.8%), bridging heterotopic ossification (8.9%), fracture (2.3%), and hardware dislocation (2.7%). Overall, there were 62 second surgeries for either revision or removal. Reasons for second surgery included heterotopic ossification (53.2%), synovectomy or capsulectomy (43.5%), and infection (3.2%). There was a statistically significant association between radiographic complications and the presence of patient symptoms (p < 0.05). There was no association between radiographic or clinical complications with age, sex, side, or type of arthroplasty (R < 0.001). CONCLUSION There is a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. By 9 months, 50% of implants showed radiographic complications.
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