scholarly journals Radial head fractures with interposed capitellar cartilage fragment–hindrance to bone healing–a case series

2021 ◽  
Author(s):  
Andreas Harbrecht ◽  
Michael Hackl ◽  
Tim Leschinger ◽  
Kilian Wegmann ◽  
Dominik Seybold ◽  
...  
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Case Series ◽  
Fracture Site ◽  
Individual Treatment ◽  
Radiological Imaging ◽  
Radial Head Fractures ◽  
Concomitant Injury ◽  
Primary Osteosynthesis

Abstract Introduction Radial head fractures account for the majority of bony elbow injuries. The individual treatment options have been described in detail. In some cases, however, an unusual concomitant injury occurs, which can significantly impede primary osteosynthesis and healing. This concomitant injury can be an interposing cartilaginous capitellar fragment. Methods This retrospective study describes four cases of trapped cartilage fragments of the capitellum that compromised primary osteosynthesis or primary conservative healing of a radial head fracture. Radiological imaging, function and pain level are presented pre- and postoperatively (mean follow-up 9.25 months). Results None of the four cases showed preoperative evidence of an incarcerated cartilage fragment of the capitellum. They all showed limited elbow range of motion. CT examinations were performed in all cases. In each case, the cartilage fragment was first sighted upon surgery, subsequently removed and the fractures treated with ORIF. Mean follow-up was of 9.25 months. All fractures healed, with excellent function and low pain scores. Conclusions This study presents rare cases of a trapped humeral cartilage fragment in radial head fractures. Radiological imaging including CT scans cannot reliably detect this concomitant injury. Therefore, this problem becomes apparent and treatable only during surgery. A high degree of suspicion is necessary especially in patients with minimally displaced fractures associated with limited elbow motion and a gap at the fracture site as treating these injuries conservatively may lead to poor outcome.

scholarly journals Complex Elbow Dislocations and the “Terrible Triad” Injury

2017 ◽  
Vol 11 (1) ◽  
pp. 1394-1404 ◽  
Author(s):  
Alistair D.R. Jones ◽  
Robert W. Jordan
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Significant Risk ◽  
Case Series ◽  
Anterior Dislocation ◽  
Current Evidence ◽  
Rotational Instability ◽  
Terrible Triad ◽  
Radial Head Fractures

Background:The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. These injuries can be categorised into groups according to their mechanism and the structures injured.Methods:This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries.Results:All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. Dislocations with radial head fractures should be treated by restoring stability, with treatment choice depending on the type and size of radial head fracture. Terrible triad injuries necessitate operative treatment in almost all cases. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism.Conclusion:Complex elbow dislocations are injuries with significant risk of long-term disability. There are several case-series in the literature but few studies with sufficient patient numbers to provide evidence over level IV.

scholarly journals Radial Head Arthroplasty: Does Ligaments Repair Influence Outcomes? A Minimum Two Years Follow-Up Radiographic Multi-Center Study

2021 ◽  
Author(s):  
Cristina Galavotti ◽  
Sara Padovani ◽  
Alessandro Nosenzo ◽  
Margherita Menozzi ◽  
Pietro Maniscalco ◽  
...  
Keyword(s):  
Radial Head ◽  
Revision Rate ◽  
Radial Head Fracture ◽  
Degenerative Changes ◽  
Annular Ligament ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Multi Center Study ◽  
Center Study

Abstract Purpose: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic-degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two-years follow up. The secondary aim was to delineate a trend profile of RHA implants.Methods: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients’ charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. Results: In six years 124 RHA were implanted (74 Female, 50 Male, mean age 56). The main diagnoses were: terrible-triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the two groups, nevertheless the cohort of patients that underwent ligaments repair had a lower revision rate in comparison to the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%.Conclusion:This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at mid-term follow-up.

scholarly journals Detachment of Extensor Carpi Ulnaris and Anterior Branches of the Radial Collateral Ligament from the Epicondyle: A Modification of Kocher Lateral Approach for the Treatment of Radial Head Fractures

Joints ◽  
2019 ◽  
Vol 07 (02) ◽  
pp. 031-036
Author(s):  
Georgios Touloupakis ◽  
Elena Biancardi ◽  
Stefano Ghirardelli ◽  
Guido Antonini ◽  
Cornelio Crippa
Keyword(s):  
Radial Head ◽  
Soft Tissues ◽  
Case Series ◽  
Lateral Approach ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radial Head Fractures ◽  
Radial Collateral Ligament

Abstract Purpose The aim of this study is to present clinical results of a retrospective case series that includes patients treated with an extensive modification of the Kocher lateral approach to the elbow with surgical detachment of the anterior branches of the radial collateral ligament. Methods From January 2016 to January 2018, nine patients with closed isolated displaced or multifragmentary radial head fractures (Mason type II, III, or IV) who underwent osteosynthesis or arthroplasty through a modified Kocher lateral elbow approach were available for follow-up. Results There were six female and three male patients. The median age at the time of surgery was 52 years old (range: 26–70). The dominant upper limb was injured in 22.2% of patients. After a median follow-up of 8 (range: 6–27) months, all patients regained completely all their daily activities and no cases of infections were recorded. Conclusion We believe that the approach proposed can be a useful choice to deal with these challenging injuries. Our strategy may represent a valid alternative to more popular approaches as the use of anchors decreases the risk of instability that is the major danger considered in the past when soft tissues as tendons and ligaments are detached. Level of Evidence This is a level IV study (therapeutic case series).

Acute Radial Head Resection for Fracture: are We Likely to Miss an Essex-Lopresti Injury?

2021 ◽  
Vol 23 (4) ◽  
pp. 263-270
Author(s):  
Dafang Zhang ◽  
Kyra A. Benavent ◽  
George S. M. Dyer ◽  
Brandon E. Earp ◽  
Philip Blazar
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Radial Head Fractures ◽  
Pain Scores ◽  
Radial Head Resection ◽  
Forearm Instability ◽  
Level I ◽  
Pull Tests ◽  
Essex Lopresti

Background. Given the current available evidence, surgical treatment of radial head fracture with acute resection is controversial. The aim of this study was to determine whether acute resection of the radial head for a radial head fracture leads to longitudinal forearm instability due to a missed Essex-Lopresti injury. Material and methods. A retrospective review was conducted of radial head resections performed for acute radial head fractures at two Level I trauma centers from 2000 to 2018. A total of 11 patients met inclusion criteria. Our primary outcome was a missed Essex-Lopresti injury at time of final clinical follow-up. Long-term telephone follow-up was attempted for QuickDASH, pain scores, and satisfaction scores. Results. Of the 11 radial head fractures in this study, intraoperative radial pull tests were performed and normal in 6 patients. No patient was found to have a missed Essex-Lopresti injury at a mean of 36.2 months’ clinical follow-up after radial head resection. At a mean telephone follow-up of 12.6 years in available patients, mean QuickDASH was 3.4, mean satisfaction was 9.75 out of 10, and no further complication or reoperation was reported. Conclusion. Our findings challenge the dogma that the radial head cannot be safely excised in the setting of acute fracture, even with elbow instability and/or wrist pain, particularly when intraoperative longitudinal stability is assessed by a stress maneuver.

scholarly journals Evaluation of two different types of radial head prosthesis in practical use. Using either Evolve® or MoPyC® radial head prosthesis in the treatment of comminuted radial head fractures

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Tim Friedrich Raven ◽  
Lukas Banken ◽  
Gerhard Schmidmaier ◽  
Stefan Studier-Fischer ◽  
Bahram Biglari ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Radial Head Prosthesis ◽  
Radial Head Fractures ◽  
Functional Scores ◽  
System Assessment ◽  
And Function ◽  
Comminuted Radial Head Fracture

The aim of this retrospective study was to undertake a comparative evaluation of the Evolve® modular metallic radial head implant prosthesis and the MoPyC® pyrocarbon prosthesis in acute care. Seventyfive patients having a comminuted radial head fracture with an Evolve® prosthesis (=G1) and 11 with a MoPyC® prosthesis (=G2) were available for a follow-up. Postoperative patient outcomes were evaluated according to a standardized follow-up protocol which included the Morrey rating system. Assessment criteria were range of motion (ROM), functional scores, and rate of complications. G1 showed a mean Morrey score of 86 points. Four direct prosthesis complications were observed in this group (n=75). The average achieved Morrey score in G2 was 84 points. In this group (n=11), 2 direct prosthesis complications were diagnosed. The average range of motion did not differ greatly between both groups. Radial head replacement with either prosthesis yielded sufficient to satisfactory results in a mid-term perspective regarding the range of motion and function of the elbow joint when performed in carefully selected patients. The Evolve® Prothesis appears to show a slightly lower rate of complication by way of a similar functional outcome.

INTERNAL FIXATION OF RADIAL HEAD FRACTURES WITH AN INTRAMEDULLARY NAIL

2013 ◽  
Vol 25 (01) ◽  
pp. 1350007
Author(s):  
Matija Krkovic ◽  
Miha Brojan ◽  
David Bombac ◽  
Dejan Hermann
Keyword(s):  
Intramedullary Nail ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Vascular Supply ◽  
General Idea ◽  
Stable Fixation ◽  
Radial Head Fractures ◽  
Design And Manufacturing ◽  
Comminuted Fractures ◽  
Thin Walled

Comminuted fractures of the radial head still present significant technical and surgical challenges. In this article, we describe a novel fixation of comminuted radial head fractures with the help of an intramedullary nail. Experiments with solid, conventionally machined intramedullary nails showed some major drawbacks in the fixation of radial head fractures. Several design and manufacturing procedures were proposed. The general idea behind the new design was the concept of a nail which would eliminate the need for prefabricated bores. Experiments with a selective laser sintered thin-walled nail, designed with the help of CT images, fulfilled expectations. This thin-walled proximal radius nail thus offers a stable fixation of the radial head fracture fragments, with the ability to preserve the existing vascular supply to the radial head fragments, and therefore not just use the reconstructed radial head as a bioprosthesis.

scholarly journals A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

2020 ◽  
Author(s):  
Xu Gao ◽  
Fei Li ◽  
Yong-Qiang Sui ◽  
Rui Huang ◽  
Hai-yu Fan ◽  
...  
Keyword(s):  
Radial Head ◽  
Plate Fixation ◽  
Visual Analog Scale Score ◽  
Reconstruction Technique ◽  
Hybrid Technique ◽  
Self Assessment ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Intramedullary Pinning

Abstract BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

Elbow Trauma

2019 ◽  
pp. 62-64
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Operative Treatment ◽  
Radial Head ◽  
Preoperative Assessment ◽  
The Body ◽  
Synovial Joint ◽  
Radial Head Fractures ◽  
Elbow Trauma ◽  
Acute Injuries ◽  
Large Joint

Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the second most commonly dislocated large joint of the body. Radiographs are the mainstay in the evaluation of acute injuries and treatment follow-up. CT examination is helpful in preoperative assessment of complex fractures/injuries. All elbow dislocations are initially close reduced and splinted. Further conservative versus operative treatment depends on complexity of injury.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury. Methods A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups. Results In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS. Conclusions With an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

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