Radial Head Arthroplasty, Excision and Osteosynthesis in Complex Elbow Fracture–Dislocations in Young Adults: What is Preferred?

Background: Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands. Methods: A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures. Results: A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05). Conclusions: Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.

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The Effect of Monteggia and Transolecranon Fracture-Dislocations on Outcomes of Radial Head Arthroplasty

OrthoMedia ◽

10.1302/3114-220945 ◽

2022 ◽

Keyword(s):

Radial Head ◽

Radial Head Arthroplasty ◽

Fracture Dislocations

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Modern radial head arthroplasty for terrible triad fracture-dislocations: a retrospective case series with minimum 3-year follow-up

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.12.012 ◽

2021 ◽

Author(s):

Noelle L. Van Rysselberghe ◽

Brett Salazar ◽

Malcolm R. DeBaun ◽

L. Henry Goodnough ◽

Justin F. Lucas ◽

...

Keyword(s):

Radial Head ◽

Case Series ◽

Terrible Triad ◽

Retrospective Case ◽

Radial Head Arthroplasty ◽

Retrospective Case Series ◽

Fracture Dislocations

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

Hand ◽

10.1177/1558944720918358 ◽

2020 ◽

pp. 155894472091835 ◽

Cited By ~ 1

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.

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Long-Term Outcomes of Radial Head Arthroplasty in Complex Elbow Fracture Dislocation

Journal of Clinical Medicine ◽

10.3390/jcm10163488 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3488

Author(s):

Alvin Chao-Yu Chen ◽

You-Hung Cheng ◽

Chih-Hao Chiu ◽

Chun-Ying Cheng ◽

Yi-Sheng Chan

Keyword(s):

Radial Head ◽

Pearson Correlation ◽

Fracture Dislocation ◽

Elbow Fracture ◽

Periprosthetic Osteolysis ◽

Radial Head Arthroplasty ◽

The Difference ◽

Elbow Fracture Dislocation

The purpose of the current study was to investigate the long-term outcomes of radial head arthroplasty in complex elbow injuries through radiographic analysis and functional correlation. We evaluated 24 radial head arthroplasties in 24 consecutive patients with complex elbow fracture dislocation. All patients were treated with a single type of modular monopolar prosthesis containing smooth stem in press-fit implantation. Clinical survey using the Mayo Elbow Performance Score (MEPS), self-reported scales of shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the visual analog scale (VAS) at more than 10-year follow-up were reported and compared to 2-year outcomes. Periprosthetic osteolysis was measured in the 10 zones of prosthesis-cortical interface with a modified radiolucency score, which was calibrated by each prosthesis size. Pearson correlation analysis was performed to detect the association between periprosthetic radiolucency and clinical assessment. At the final follow-up, MEPS, QuickDASH score and VAS score averaged 82.5 ± 15, 14.1 ± 14.3 and 1.6 ± 1.2 respectively. A decline in functional status was noted, with decreased mean MEPS and increased mean QuickDASH and VAS scores as compared to the 2-year results while the difference was insignificant. Periprosthetic osteolysis was more prevalent around stem tip of zone 3 and zone 8. The final and 2-year radiolucency scores averaged 7.4 ± 4.2 and 2.6 ± 2.3 respectively with significant difference. Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in MEPS/QuickDASH/VAS was −0.836, 0.517 and 0.464. Progression of periprosthetic osteolysis after postoperative 10 years is more prevalent around the stem tip with moderate to high correlation to clinical outcomes. Sustained follow-up is warranted to justify subsequent surgery for revision or implant removal.

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Factors influencing the mid-term radiological and functional outcomes of 41 post-fracture bipolar radial head arthroplasty cases at a mean follow-up of 87 months

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.102818 ◽

2021 ◽

pp. 102818

Author(s):

Pierre-Sylvain Marcheix ◽

Céline Cuenca ◽

Guillaume Vergnenegre ◽

Christian Mabit ◽

Jérémy Hardy ◽

...

Keyword(s):

Radial Head ◽

Functional Outcomes ◽

Radial Head Arthroplasty ◽

Factors Influencing

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A registry study on radial head arthroplasties in the Netherlands: Indications, types and short-term survival

Shoulder & Elbow ◽

10.1177/1758573220987843 ◽

2021 ◽

pp. 175857322098784

Author(s):

Arno A Macken ◽

Ante Prkić ◽

Koen LM Koenraadt ◽

Iris van Oost ◽

Anneke Spekenbrink-Spooren ◽

...

Keyword(s):

Radial Head ◽

Register Data ◽

Implant Survival ◽

Short Term ◽

Term Survival ◽

Arthroplasty Register ◽

Common Indication ◽

Radial Head Arthroplasty ◽

Kaplan Meier ◽

Short Term Survival

Background This study aims to use the Dutch Arthroplasty Register data to report an overview of the contemporary indications and implant designs, and report the short-term survival of radial head arthroplasty. Methods From the Dutch Arthroplasty Register, data on patient demographics, surgery and revision were extracted for radial head arthroplasties performed from January 2014 to December 2019. Implant survival was calculated using the Kaplan–Meier method. Results Two hundred fifty-eight arthroplasties were included with a median follow-up of 2.2 years. The most common indication was a fracture of the radial head (178, 69%). One hundred thirty-nine (68%) of the prostheses were of bipolar design, and the most commonly used implant type was the Radial Head System (Tornier; 134, 51%). Of the 258 included radial head arthroplasties, 16 were revised at a median of six months after surgery. Reason for revision was predominantly aseptic loosening (9). The overall implant survival was 95.8% after one year, 90.5% after three years and 89.5% after five years. Discussion For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. The implant survival is 89.5% after five years.

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Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function

Case Reports in Orthopedics ◽

10.1155/2018/8295736 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Catherine Kilmartin ◽

Katharine D. Harper ◽

Chirag Mehta ◽

Joseph Thoder ◽

Andrew Newman

Keyword(s):

Limb Salvage ◽

Free Flap ◽

Radial Head ◽

Radial Head Prosthesis ◽

Review Of The Literature ◽

Joint Function ◽

Radial Head Arthroplasty ◽

Elbow Function ◽

Fibular Free Flap ◽

Proximal Forearm

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius. The patient has sustained a 5.5 cm epiphyseal radial defect with an associated 20 × 15 cm overlying tissue defect after serial debridement. In review of the literature, only one nontraumatic case using a combined free flap and radial head prosthesis for proximal forearm defect to restore joint function has been reported. We suggest that, for proximal forearm fractures, this technique can be used to restore elbow joint function in limb salvage.

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