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Kiechle M, Thannheimer A, Hungerer S, Friederichs J, Bühren V, Von Rüden C. Long-term Outcomes after Primary Radial Head Resection Arthroplasty vs. Acute Radial Head Resection vs. Secondary Prosthetic Removal in Comminuted Radial Head Fractures. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:112-117. [PMID: 31211189 PMCID: PMC6510922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Aim of this study was to compare the clinical and radiological long-term outcomes following operative treatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial head resection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fractures combined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty could contribute to ligament healing. METHODS In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients with comminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinically and radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores. RESULTS After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial head resection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twenty patients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49 points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Broberg and Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards better results and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3 compared to group 2 (P=0.02). CONCLUSION Clinical and radiological long-term results of this study demonstrate a trend towards a better outcome after acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fractures associated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement in cases of comminuted non-reconstructable radial head fractures.
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Affiliation(s)
- Martin Kiechle
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Andreas Thannheimer
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Sven Hungerer
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Volker Bühren
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
| | - Christian Von Rüden
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Department of Trauma Surgery, BG Trauma Center Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Research performed at BG Trauma Center Murnau, Murnau, Germany
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SALVI ANDREAEMILIO. Mason type 3 radial head fractures: proposal of a synthesis technique using bioabsorbable thread. JOINTS 2016; 4:126-128. [PMID: 27602353 PMCID: PMC4993547 DOI: 10.11138/jts/2016.4.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Multifragmentary fractures of the radial head (Mason type 3) are challenging for the surgeon. They are usually treated by means of complete removal of the injured head and sometimes by implantation of a metal prosthesis. Indeed, the bone fragments are often too small to allow stabilization through screws or even wires. The Author proposes an alternative technique, tested on a sawbone model, in which bioabsorbable thread is used, introduced in a figure-of-eight fashion. A review of the literature is provided.
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Affiliation(s)
- ANDREA EMILIO SALVI
- Corresponding Author: Andrea Emilio Salvi, MD, Department of Orthopaedics and Traumatology, A.S.S.T. Franciacorta, Civil Hospital of Chiari, Via Cipro 30, 25124 Brescia, Italy, E-mail:
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