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Mulders MAM, Schep NWL, de Muinck Keizer RJO, Kodde IF, Hoogendoorn JM, Goslings JC, Eygendaal D. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1670-1678. [PMID: 33753275 DOI: 10.1016/j.jse.2021.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Izaäk F Kodde
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Deventer Hospital, Deventer, the Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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Haasters F, Helfen T, Böcker W, Mayr HO, Prall WC, Lenich A. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures. BMC Musculoskelet Disord 2019; 20:343. [PMID: 31351457 PMCID: PMC6661091 DOI: 10.1186/s12891-019-2726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.
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Affiliation(s)
- Florian Haasters
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany. .,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Tobias Helfen
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Hermann O Mayr
- Department of Orthopaedics and Traumatology, Freiburg University Hospital, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg im Breisgau, Germany
| | - Wolf Christian Prall
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany.,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Andreas Lenich
- Department of Orthopedic Sports Medicine, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Li T, Li XL, Hu SX, Sun W, Wu J. Evaluation of effect and safety of arthroscopic surgery with three different operative approaches in patients with terrible triad of the elbow: A comparative study. Medicine (Baltimore) 2018; 97:e0398. [PMID: 29642203 PMCID: PMC5908638 DOI: 10.1097/md.0000000000010398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The terrible triad of the elbow (TTE) is a difficult injury, and the usual TTE consists of posterior dislocation of the elbow, radial head fracture, and coronoid fracture. The target of this retrospective study is to explore the effect, postoperative complications, and prognostic factors in patients with TTE undergoing arthroscopic surgery with three different operative approaches. METHODS Patients with TTE underwent arthroscopic surgery were treated using lateral, anterior medial, or combined lateral and anterior medial approaches, respectively. In order to analyze the postoperative complications and the effect of arthroscopic surgery for patients with TTE, the function of elbow joint before and after the surgery was evaluated and the flexion-extension of elbow joint and rotation of elbow joint and forearm were measured. RESULTS The evaluation results obtained from patients underwent 3 different operative approaches revealed that after surgery, patients receiving arthroscopic surgery using combined lateral and anterior medial approach had superior flexion-extension of elbow joint, rotation of elbow joint and forearm, higher Mayo Elbow Performance Score (MEPS) and more cases of Broberg-Morrey grade 0, and lower complication rate, compared with those using lateral or anterior medial approach. A key finding in the study demonstrated that fracture type, operative approach, and postoperative complications were factors related with the effect of arthroscopic surgery for patients with TTE. CONCLUSION Collectively, the key findings obtained from the present study supported the notion that the effect of arthroscopic surgery in combined lateral and anterior medial approach is much better than in lateral approach or anterior medial approach, and is related with fracture type, operative approach, and postoperative complications.
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Affiliation(s)
- Tao Li
- Department of Emergency and Trauma Surgery, Jining No.1 People's Hospital, Jining
| | - Xing-Long Li
- Department of Orthopedics, Yankuang Group Genaral Hospital, Zoucheng
| | - Shi-Xiang Hu
- Department of Surgery, Xizou Health Center of Qufu, Qufu
| | - Wei Sun
- Department of Surgery, Taiping Town Health Center of Zoucheng, Zoucheng, P.R. China
| | - Jing Wu
- Department of Emergency and Trauma Surgery, Jining No.1 People's Hospital, Jining
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Crönlein M, Zyskowski M, Beirer M, Imhoff FB, Pförringer D, Sandmann GH, Kirchhoff C, Biberthaler P, Siebenlist S. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 2017; 137:789-795. [PMID: 28432459 DOI: 10.1007/s00402-017-2693-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized. MATERIALS AND METHODS Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey elbow performance score (MEPS), the QuickDASH and the elbow self-assessment score (ESAS). Furthermore, follow-up radiographs were reviewed. RESULTS Between 2011 and 2014 a total of 24 patients were managed with ORIF using anatomically preshaped low-profile locking plates. All patients had suffered from comminuted radial head fractures (type III-IV according to Mason classification). Twenty of 24 patients returned for follow-up examination after a mean of 30 months (range 18-53 months). Patients' satisfaction was rated as highly satisfied in 17 cases and satisfied in 3 cases. An unrestricted ROM for extension-flexion arc and pronation-supination arc was rated in 10 cases. Minor ROM deficiencies with a 5° limited extension compared to the contralateral side was evaluated in 6 cases. Only four patients were rated with and extension and supination deficiency of 10°, one of whom with an additional pronation deficiency of 10°. The calculated MEPS was Ø 98 ± 4 (range 85-100), and the QuickDASH was Ø 3 ± 6 (range 0-21). The ESAS was completed by 18 patients with a mean of Ø 96.54 ± 2.95 (range 94-100) indicating a non-restricted elbow function. CONCLUSIONS The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates.
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Affiliation(s)
- Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Chen HW, Wang ZY, Wei GS. Evaluation of the therapeutic effects of lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow. Biomed Pharmacother 2017; 91:748-754. [PMID: 28499246 DOI: 10.1016/j.biopha.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the therapeutic effects of the lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow. METHODS Between June 2010 and January 2015, 334 patients suffering from terrible triad of the elbow, amongst whom 105 cases underwent lateral approaches combined with anteromedial approaches, 112 cases underwent lateral approaches, and 117 cases underwent anteromedial approaches were included in the study. The serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were detected using enzyme-linked immunosorbent assay (ELISA) before operation and at 7 days and 3 months after operation. X-ray imaging was employed to examine the recovery condition of the elbow, and the joint motion and the forearm rotation of elbow were evaluated before and after the operation. RESULTS Excellent rate was obtained in accordance with the Mayo Elbow Performance Score (MEPS). The serum levels of CRP, IL-6, IL-8 and TNF-α gradually decreased to normal levels after the operation, and recovery was faster in patients undergoing lateral approach combined with anteromedial approach in comparison to those undergoing lateral and anteromedial approaches. The X-ray images showed good recovery of elbows in all patients, but the range of joint motion, forearm rotation degree, and MEPS were higher in patients undergoing lateral approach combined with anteromedial approach compared to those undergoing lateral and anteromedial approaches independently. CONCLUSION Taken together, these findings demonstrate lateral approach combined with anteromedial approach reveals better therapeutic effect than lateral approach and anteromedial approach in the treatment of terrible triad of the elbow.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedics, Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, PR China.
| | - Zi-Yang Wang
- Department of Orthopedics, Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, PR China
| | - Geng-Sheng Wei
- Department of Orthopedics, Beijing Haidian Section of Peking University Third Hospital, Beijing 100080, PR China
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