scholarly journals Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system

2020 ◽  
Author(s):  
K. Wegmann ◽  
M. Hackl ◽  
T. Leschinger ◽  
K. J. Burkhart ◽  
L. P. Müller
Keyword(s):  
Radial Head ◽  
Classification System ◽  
Present Review ◽  
Low Grade ◽  
Type I ◽  
Joint Stability ◽  
Common Procedure ◽  
Physiological Level ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement

Abstract Background Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. Methods The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. Results In low-grade overlengthening (type I) conservative treatment can be an option. In Types II–IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. Discussion The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.

scholarly journals Radial head fractures

2019 ◽  
Vol 12 (3) ◽  
pp. 212-223 ◽  
Author(s):  
RP van Riet ◽  
MPJ van den Bekerom ◽  
A Van Tongel ◽  
C Spross ◽  
R Barco ◽  
...  
Keyword(s):  
Radial Head ◽  
Long Term Results ◽  
Valgus Stress ◽  
Proximal Ulna ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Treatment Type ◽  
Radial Head Resection ◽  
Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions

2019 ◽  
Vol 101-B (12) ◽  
pp. 1512-1519 ◽  
Author(s):  
Alexander Klug ◽  
Felix Konrad ◽  
Yves Gramlich ◽  
Reinhard Hoffmann ◽  
Kay Schmidt-Horlohé
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Type I ◽  
Dash Score ◽  
Type Ii ◽  
Coronoid Fracture ◽  
Radial Head Arthroplasty ◽  
Type Iii ◽  
Clinical And Radiological Results

Aims The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

scholarly journals Simultaneous Fractures of Proximal and Distal End of Radius. An Unusual Pattern of Complex Injuries and Clinical Review

2019 ◽  
Vol 4 (09) ◽  
Author(s):  
Kastanis G ◽  
Spyrantis M. ◽  
Magarakis G. ◽  
Kapsetakis P. ◽  
Pantouvaki A.
Keyword(s):  
Distal Radius ◽  
Radial Head ◽  
Locking Plate ◽  
Radial Head Fracture ◽  
The Other ◽  
Type I ◽  
Volar Locking Plate ◽  
Radial Head Replacement ◽  
Preoperative Magnetic Resonance ◽  
Complex Injuries

While the isolated fractures of proximal or distal radius are very common injuries in adults and account to 14% and 18% of all extremity fractures the simultaneous ipsilateral fractures of proximal and distal end of radius are quite uncommon. We present two cases (females 64 and 56 years old) with ipsilateral fractures of radial head and distal end of radius due to a fall. No signs of ligamentous injuries were found in preoperative magnetic resonance imaging’s (MRI). Firstly we treated the distal radius fracture in both cases with volar locking plate, secondly we approached the radial head fracture: in one case (Maison type I) conservatively (plaster of Paris) and in the other case (Maison type III) with radial head replacement. The aim of this study has two objectives: first to increase the awareness of diagnosing this bipolar injury in the emergency department and second to introduce the modalities of treatment.

scholarly journals Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Matthias Jung ◽  
Corinna Groetzner-Schmidt ◽  
Felix Porschke ◽  
Paul A. Grützner ◽  
Thorsten Guehring ◽  
...  
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Dash Score ◽  
Performance Score ◽  
Analog Scale ◽  
Mayo Elbow Performance Score ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
The Mean

Abstract Background The aim of the study was to analyze the functional and radiological outcome of Monteggia-like lesions in adults with unreconstructible fracture of the radial head and treatment with radial head arthroplasty. Methods Twenty-seven patients (mean age 56 years; range 36 to 79 years) with a Monteggia-like lesion and treatment with radial head replacement were included in this retrospective study. Minimum follow-up was 2 years. Clinical assessment included the pain level with the visual analog scale in rest (VASR) and under pressure (VASP), range of motion, Mayo Elbow Performance Score (MEPS), and Disability of the Arm, Shoulder, and Hand score (DASH). A detailed radiological evaluation was performed. Complications and revisions were also analyzed. Results After a mean follow-up period of 69 months (range, 24 to 170) the mean DASH score was 30 ± 24, the MEPS averaged 77 ± 20 points, the mean VASR was 2.1 ± 2.4, and VASP was 4.5 ± 3.5. Mean loss of extension was 24° ± 18 and flexion was 124° ± 20. Heterotopic ossifications were noted in 12 patients (44%). A total of 17 complications were noted in 11 patients (41%), leading to 15 revision surgeries in 9 patients (33%). Patients with a complicated postoperative course showed a worse clinical outcome compared with patients without complications measured by MEPS (68 ± 22 vs. 84 ± 16), DASH (49 ± 16 vs. 20 ± 22) and ulnohumeral motion (77° ± 31 vs. 117° ± 23). Conclusions Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions.

scholarly journals Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study

2019 ◽  
Vol 7 (9) ◽  
pp. 1505-1508 ◽  
Author(s):  
Ayush Kumar Singh ◽  
Aswini Jidge ◽  
Ujwal Ramteke ◽  
Nivedhitha Venkateswaran ◽  
Hemlata Rokade ◽  
...  
Keyword(s):  
Comparative Study ◽  
Radial Head ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Prospective Comparative Study ◽  
The Difference ◽  
Type Of Injury ◽  
Radial Head Excision

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.

Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture

Hand ◽  
2020 ◽  
pp. 155894472091835 ◽  
Author(s):  
Casey M. O’Connor ◽  
Joost Kortlever ◽  
Gregg A. Vagner ◽  
Lee M. Reichel ◽  
David Ring
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fracture ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Radial Head Arthroplasty ◽  
Factors Associated ◽  
Radial Head Replacement ◽  
Patient Variables

Background: The decision between radial head arthroplasty and open reduction internal fixation in the context of a terrible triad elbow fracture-dislocation is debated. This study investigated both surgeon and patient factors associated with surgeons’ recommendations to use arthroplasty. Methods: One hundred fifty-two surgeon members of the Science of Variation Group participated. Surgeons were asked to complete an online survey that included surgeon demographics and 16 patient scenarios. The patient scenarios were randomized using 2 patient variables and 2 anatomical variables. Multilevel logistic mixed regression analysis was performed to identify surgeon and patient variables associated with recommendations for radial head arthroplasty. Results: We found that radial head replacement was recommended in 38% of the scenarios. Scenarios with older patients, with fractures of the whole head, and those involving 3 fracture fragments were independently associated with radial head replacement. Conclusion: We found that most surgeons recommended radial head fracture fixation rather than arthroplasty. Surgeons were more likely to recommend fixation for younger patients with partial articular fractures or with fractures with 3 or fewer fracture fragments. It seems that surgeons are uneasy about using a prosthesis in a young active patient.

scholarly journals Radial Head Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 1405-1416 ◽  
Author(s):  
Robert W. Jordan ◽  
Alistair DR. Jones
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Modular Design ◽  
Management Strategies ◽  
Type I ◽  
Complication Rates ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Anatomic Reduction ◽  
Elbow Injuries

Background:Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries.Methods:A literature search was performed and the authors’ personal experiences are reported.Results:Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon’s ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation.Conclusion:We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.

scholarly journals Radial head fractures in young, active patients

2020 ◽  
Vol 15 (4) ◽  
pp. 251-259
Author(s):  
Christopher G. Larsen ◽  
Michael J. Fitzgerald ◽  
Andrew S. Greenberg
Keyword(s):  
Radial Head ◽  
Young Patients ◽  
Elbow Dislocation ◽  
Early Mobilization ◽  
High Energy ◽  
Type I ◽  
Type Ii ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Active Patients

AbstractThe radial head is an important stabilizer of the elbow joint. Radial head fractures are commonly associated with additional injuries to the ligamentous structures of the elbow and can significantly compromise elbow stability. Young patients with radial head fractures are more likely to be male and present after a high-energy mechanism of injury. While not perfect, the Mason classification is the most commonly used classification system and can help to guide the management of radial head fractures. Type I fractures are nondisplaced or minimally displaced (less than 2 mm) and are treated nonoperatively with early mobilization. Type II fractures, which are displaced 2–5 mm, can be treated nonoperatively or with open reduction and internal fixation (ORIF). Type III fractures are comminuted and are most often treated with ORIF or with radial head arthroplasty (RHA). Treatment of fractures with an associated elbow dislocation (Mason type IV) is also with ORIF or RHA depending on the degree of comminution. For all of these injuries, assessment and treatment of associated ligamentous injuries are necessary in conjunction with treatment of the bony injury. Despite a significant body of literature available on radial head fractures, there is controversy regarding the optimal management of type II, III, and IV fractures, especially in young, active patients. Common complications following radial head fractures include stiffness, instability, and posttraumatic osteoarthritis; as such, these injuries can lead to significant disability in young, active patients if not managed appropriately.

KPS Bipolar Radial Head Arthroplasty – Polyethylene Head Replacement with a Metal-covered Head. Case Study

2018 ◽  
Vol 20 (3) ◽  
pp. 229-237
Author(s):  
Kamila Malesa ◽  
Mariusz Urban ◽  
Dariusz Michalik ◽  
Stanisław Pomianowski
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Surgical Procedures ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Therapeutic Results

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been ob­tained, this procedure, like any other surgical procedures, may be associated with severe complications, includ­ing contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has al­ways been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

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