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Mebouinz FN, Kasse A, Habib Sy M. Results of radial head resection after Mason type 3 or 4 fracture of the elbow. Clin Shoulder Elb 2020; 23:131-135. [PMID: 33330247 PMCID: PMC7714292 DOI: 10.5397/cise.2020.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/05/2023] Open
Abstract
Background Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.
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Affiliation(s)
- Ferdinand Nyankoue Mebouinz
- Department of Orthopedic Trauma Surgery, Idrissa Pouye General Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Amadou Kasse
- Department of Orthopedic Trauma Surgery, Idrissa Pouye General Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Mouhamadou Habib Sy
- Department of Orthopedic Trauma Surgery, Idrissa Pouye General Hospital, Cheikh Anta Diop University, Dakar, Senegal
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Rebgetz PR, Daniele L, Underhill ID, Öchsner A, Taylor FJ. A biomechanical study of headless compression screws versus a locking plate in radial head fracture fixation. J Shoulder Elbow Surg 2019; 28:e111-e116. [PMID: 30685273 DOI: 10.1016/j.jse.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Fixation of a 3-part radial head fracture with cannulated compression screws will show equivalent stiffness to a locking plate under axial load. Debate exists regarding the management of Mason type III fractures, with many believing that open reduction and internal fixation provides advantages over other options. By virtue of their subarticular placement, screw fixation is less likely to cause impingement compared with plate fixation, which can result in loss of rotation and requirement for hardware removal. Insufficient fixation stability can lead to nonunions, necrosis of the radial head, pain, and instability. We tested the mechanical stability of fixation of simulated radial head fractures using headless compression screws compared with standard plate construct. METHODS Standardized test constructs were created with repeatable osteotomy cuts and hardware placement on each Synbone model (Synbone AG, Malans, Switzerland). We presectioned 22 proximal radius Synbone models to simulate a 3-part radial head fracture. The models were fixed using a radial head locking plate or headless compression screws in a tripod construct. The constructs were potted into a compression test jig using 2-part epoxy resin. Compression testing was performed using a 30-kN Instron Universal machine (Instron, Norwood, MA, USA). The compression tool was spherical, representing the surface of the capitellum. RESULTS There was no significant difference between the stiffness of the Synbone constructs under axial load. CONCLUSION There was no significant difference between fixation stiffness of a 3-part radial head fracture with headless compression screws in a tripod structure vs. a locking plate in Synbone. Further study is required to allow clinical application.
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Affiliation(s)
- Paul R Rebgetz
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - Luca Daniele
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ian D Underhill
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Andreas Öchsner
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Fraser J Taylor
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
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Zarifian A, Rahimi Shoorin H, Hallaj Moghaddam M, Fathi Vavsari M, Gharedaghi M, Moradi A. The Best Option in Treatment of Modified Mason Type III Radial Head Fractures: Open Reduction and Internal Fixation Versus Radial Head Excision. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:365-370. [PMID: 30320175 PMCID: PMC6168227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. METHODS Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. RESULTS The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11.43 months. The ranges of extension and supination, and frequency of pain reporting was significantly different between the groups. The average grip strength in the operated side was significantly higher in the ORIF group, compared with the excision (P= 0.03). Ten (100%) patients of ORIF group and 5 (50%) patients of excision group had elbow joint stability (P=0.01). Mean MEPI and DASH scores were significantly higher in ORIF group (P<0.001 and =0.04, respectively). CONCLUSION The results are in favor of ORIF method. Therefore, this method is recommended and preferred over excision in treating radial heads with Mason type III fracture.
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Affiliation(s)
- Ahmadreza Zarifian
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Rahimi Shoorin
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hallaj Moghaddam
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Meysam Fathi Vavsari
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Gharedaghi
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Research performed at Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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Chen H, Wu D, Pan T, Pan J, Zhang R, Shi X. Comparison of three different fixation constructs for radial neck fractures: a biomechanical study. J Orthop Surg Res 2017; 12:175. [PMID: 29137658 PMCID: PMC5686797 DOI: 10.1186/s13018-017-0680-2] [Citation(s) in RCA: 5] [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: 06/07/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022] Open
Abstract
Background Fixation of radial neck fractures can be achieved with a plate and screw construct or with two screws. This study evaluated the biomechanical properties of three different fixation methods following radial neck fractures. Methods Twenty-four fourth-generation composite radii were sawed to simulate an unstable radial neck fracture. They were then instrumented with a plate and screw construct or two different orientations (crossed and parallel) of screw fixation. Implants were tested under bending and torsional loads via a tension torsion composite test system. Bending and torsional failure loads were added to the remaining implant-radius constructs if they did not fail during the previous tests. Results During the bending loading test, the crossed-screw group showed the greatest stiffness, followed by the parallel-screw group, the plate group demonstrating the weakest stiffness. There was no significant difference between the crossed- and the parallel-screw groups. However, there was a significant difference between the two screw groups and the plate group. During the bending failure test, the largest stiffness was found for the crossed-screw group, while the plate group exhibited the smallest stiffness. There was a significant difference between the three groups. During the torsion loading test, the highest stiffness was observed for the crossed-screw group, while the plate group showed the lowest stiffness. In the torsion failure test, the failure torques were 11.97 ± 2.659, 8.531 ± 1.768, and 7.079 ± 1.666 N m respectively for the crossed-screw, parallel-screw, and plate groups. There was a significant difference between the crossed-screw group and the two other groups. Conclusions Crossed screws and plate fixation are commonly used in clinical practice to treat simple radial neck fractures. While the present study shows that the parallel-screw method results in similar biomechanical strength as the two other techniques, it has the advantages of reaching limited wound exposure and having the implant buried. Therefore, it may be widely used in clinical practice.
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Affiliation(s)
- Hongwei Chen
- Department of Orthopaedics Surgery, Yiwu People's Hospital, NO.699, Jiangdong Road, Yiwu, Zhejiang Province, 322007, China
| | - Dengying Wu
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325027, China
| | - Tianlong Pan
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325027, China
| | - Jun Pan
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325027, China
| | - Rui Zhang
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325027, China
| | - Xuchao Shi
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325027, China.
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Shetty SK, Shetty A, Balan B, Ballal A, Rai H, Hegde A. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques. J Clin Diagn Res 2017; 11:RC01-RC03. [PMID: 28384945 PMCID: PMC5376771 DOI: 10.7860/jcdr/2017/22051.9379] [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: 06/14/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The management of displaced and comminuted radial head fractures has been a matter of debate amongst surgeons for many years. Radial head excision formed the mainstay of surgical management of these injuries. Over the years, there have been improvements in the surgical techniques and availability of better implants and instrumentation techniques, hence, open reduction and internal fixation of these fractures is gaining popularity. AIM To compare the outcome of elbow function between radial head excision and open reduction and internal fixation of the radial head with mini screws of Mason Type II and Type III radial head fractures and to assess the complications that occur in both techniques. MATERIALS AND METHODS A prospective study was conducted in the Department of Orthopaedic Surgery of Justice K.S.Hegde Charitable hospital. A total of 40 patients between the age group of 30-50 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. Group I consisted of 20 patients who underwent radial head excision and Group II consisted of 20 patients who underwent open reduction and internal fixation with mini screws. Patients were reviewed at postoperative week 3, 6 and 24. Radiographs were taken and functional outcome assessment of the elbow was done during all the follow ups. Elbow physiotherapy was started on postoperative week three. Scoring of elbow function was done as per the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. Results were tabulated, compared and analysed statistically using the 'chi-square test'. RESULTS At the end of six months, the patients of the open reduction and internal fixation group had lower DASH scores (4.82±2.73 points) than the radial head excision group (14.23±5.60 points). This inferred that patients who underwent open reduction and internal fixation had better functional outcomes than the excision group. Complications of proximal radial migration was noted in three patients, elbow osteoarthritis was noted in two and periarticular ossification was noted in six patients who underwent radial head excision. CONCLUSION Open reduction and internal fixation of Mason Type II and Type III radial head fractures is a better management technique as compared to radial head excision for management of Mason Type II and III radial head fractures.
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Affiliation(s)
- Sanath Kumar Shetty
- Assistant Professor, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Ashwin Shetty
- Associate Professor, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Bijith Balan
- Postgraduate, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Arjun Ballal
- Registrar, Department of Orthopaedic Surgery, ARS Hospital, Tirupur, Tamil Nadu, India
| | - H.Ravindranath Rai
- Professor and Head, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Anoop Hegde
- Registrar, Department of Orthopaedic Surgery, ARS Hospital, Tirupur, Tamil Nadu, India
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Abstract
This study compares the outcomes of two methods of fixation of displaced fractures of the radial neck. The 58 patients with a mean age of 38.5 years (18 to 56), were treated in a non randomised study with screws (n = 29) or a plate and screws (n = 29) according to the surgeon’s preference. The patients were reviewed at one year. Radiographs and functional evaluations were carried out up to one year post-operatively, using the Broberg and Morrey functional evaluation score, range of movement, and assessment of complications. The mean functional scores did not differ significantly between groups (90 (55 to 100) vs 84; 50 to 100, p = 0.09), but the mean range of forearm rotation in screw group was significantly better than in the plate group (152°; 110° to 170° vs 134°; 80° to 170°, p = 0.001). Although not statistically significant, the screw group had a lower incidence of heterotopic ossification than the plate group (n = 1) than the plated group (n = 3) and the pathology was graded as less severe. Cite this article: Bone Joint J 2015;97-B:830–5
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Affiliation(s)
- S. L. Li
- Beijing Ji Shui Tan Hospital, No
31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Y. Lu
- Beijing Ji Shui Tan Hospital, No
31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - M. Y. Wang
- Beijing Ji Shui Tan Hospital, No
31 Xinjiekoudongjie, Xicheng District, Beijing, China
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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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Jayaram PR, Bhattacharyya R, Jenkins PJ, Anthony I, Rymaszewski LA. A new "virtual" patient pathway for the management of radial head and neck fractures. J Shoulder Elbow Surg 2014; 23:297-301. [PMID: 24524978 DOI: 10.1016/j.jse.2013.11.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/31/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a "virtual clinic." The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention. METHODS The 202 eligible patients, who presented during a 1-year period from October 2011 to October 2012, were identified retrospectively from a prospectively collected administrative database. Mason type III and IV fractures were excluded. A questionnaire was administered by mail or phone call to assess satisfaction with the process, information received, and function. RESULTS Twenty (10%) patients required face-to-face review in a clinic, whereas 182 (90%) were managed with direct discharge; 155 patients responded to the survey (77%). The overall satisfaction rate was 96% in the suspected fracture group and 87% in the definite fracture group (P = .08). Satisfaction with the information provided was 95%. Two (1%) required late surgical intervention. CONCLUSION In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases.
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Affiliation(s)
- Prem R Jayaram
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
| | - Rahul Bhattacharyya
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Paul J Jenkins
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Iain Anthony
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Lech A Rymaszewski
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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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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Kovar FM, Jaindl M, Thalhammer G, Rupert S, Platzer P, Endler G, Vielgut I, Kutscha-Lissberg F. Incidence and analysis of radial head and neck fractures. World J Orthop 2013; 4:80-84. [PMID: 23610756 PMCID: PMC3631956 DOI: 10.5312/wjo.v4.i2.80] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/12/2013] [Accepted: 04/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate several complications like persistent radial head dislocation, forearm deformity, elbow stiffness and nerve palsies, associated with radial head fractures.
METHODS: This study reviewed the clinical records and trauma database of this level I Trauma Center and identified all patients with fractures of the radial head and neck who where admitted between 2000 and 2010. An analysis of clinical records revealed 1047 patients suffering from fractures of the radial head or neck classified according to Mason. For clinical examination, range of motion, local pain and overall outcome were assessed.
RESULTS: The incidence of one-sided fractures was 99.2% and for simultaneous bilateral fractures 0.8%. Non-operative treatment was performed in 90.4% (n = 947) of the cases, surgery in 9.6% (n = 100). Bony union was achieved in 99.8% (n = 1045) patients. Full satisfaction was achieved in 59% (n = 615) of the patients. A gender related significant difference (P = 0.035) in Mason type distribution-type III fractures were more prominent in male patients vs type IV fractures in female patients-was observed in our study population.
CONCLUSION: Mason type I fractures can be treated safe conservatively with good results. In type II to IV surgical intervention is usually considered to be indicated.
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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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Early radial head excision for displaced and comminuted radial head fractures: considerations and concerns at long-term follow-up. J Orthop Trauma 2012; 26:236-40. [PMID: 22031038 DOI: 10.1097/bot.0b013e318220af4f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study is to retrospectively review the outcomes of patients with comminuted radial head fractures surgically treated with early radial head excision. DESIGN Retrospective follow-up study. SETTING University orthopaedic trauma center. PATIENTS Forty-two patients with unilateral, isolated, closed, displaced, or comminuted radial head fracture (Mason type 2-10, Type 3-32). INTERVENTION Early radial head excision. MAIN OUTCOME MEASUREMENTS Patients were clinically and radiographically evaluated at an average follow-up of 18 years. The uninjured contralateral limb was used as a comparison. Clinical evaluation was rated using the Broberg and Morrey system, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the visual analog scale (VAS) for pain. RESULTS At last follow-up, 36 patients had no complaints, whereas six admitted to occasional pain. The mean Broberg and Morrey score was 91.2 ± 6.3, and the mean Disabilities of the Arm, Shoulder and Hand score was 10.1 ± 8.8. CONCLUSION Early radial head excision represents a viable option in case of displaced and comminuted fractures. According to the results of this study, it demonstrated a high rate of good results and patient satisfaction, a quick recovery after surgery, and a low rate of complications with durable results at long-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Chen X, Wang SC, Cao LH, Yang GQ, Li M, Su JC. Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. INTERNATIONAL ORTHOPAEDICS 2011; 35:1071-6. [PMID: 20680272 PMCID: PMC3167410 DOI: 10.1007/s00264-010-1107-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 05/29/2010] [Accepted: 07/19/2010] [Indexed: 12/30/2022]
Abstract
The objective of this study was to compare replacement of the radial head by metal prostheses with open reduction and internal fixation (ORIF) for the treatment of unstable, multi-fragmented radial head fractures. A prospective randomised controlled trial was employed to investigate 45 patients with unstable, multi-fragmented fractures of the radial head, from January 2004 to June 2007. The patients were randomised to two groups: the ORIF group and the radial head replacement group. Over the next two years, follow-up assessments recorded Broberg and Morrey scores and postoperative complication rate. Statistical analysis was performed. According to Broberg and Morrey scores, patients receiving radial head replacement achieved significantly better clinical results with 91% (20/22) good or excellent compared to patients assigned to the ORIF group with 65.2% (15/23) good or excellent results (P < 0.01). Postoperative complication rate of the radial head replacement group (13.6%) was significantly lower than that of the ORIF group (47.9%; P < 0.01). Compared with open reduction and internal fixation, radial head replacement with a metal prostheses resulted in favourable joint function for the unstable, multi-fragmented fractures of the radial head.
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Affiliation(s)
- Xiao Chen
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, 200433, People's Republic of China.
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Notice of correction: Acta Orthopaedica 81(2). Acta Orthop 2010. [PMCID: PMC3214757 DOI: 10.3109/17453674.2010.526042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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