Posterolateral rotatory instability following comminuted radial head fractures: Fracture fixation versus radial head replacement versus 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.

Download Full-text

Early Complications in Total Radial Head Excision & Radial Head Replacement in Comminuted Radial Head Fractures

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i11.135 ◽

2017 ◽

Vol 5 (11) ◽

Author(s):

Prof. Dr R. Neelakrishnan ◽

Keyword(s):

Radial Head ◽

Early Complications ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

Radial Head Excision

Download Full-text

The effect of radial head prosthesis diameter on posterolateral rotatory instability of the elbow

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2018.10.005 ◽

2018 ◽

Vol 60 ◽

pp. 89-94

Author(s):

Chad E. Songy ◽

Cory G. Couch ◽

Eric R. Siegel ◽

James R. Kee ◽

Shahryar Ahmadi

Keyword(s):

Radial Head ◽

Radial Head Prosthesis ◽

Rotatory Instability ◽

Posterolateral Rotatory Instability

Download Full-text

Metallic Press-fit Radial Head Replacement for Radial Head Fractures

Orthopedics ◽

10.3928/01477447-20190604-07 ◽

2019 ◽

Vol 42 (6) ◽

pp. e545-e551

Author(s):

Ki Jin Jung ◽

Jae-Hwi Nho ◽

Soon-Do Wang ◽

Yong Cheol Hong ◽

Byung Sung Kim

Keyword(s):

Radial Head ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

Press Fit

Download Full-text

Radial head fractures

Shoulder & Elbow ◽

10.1177/1758573219876921 ◽

2019 ◽

Vol 12 (3) ◽

pp. 212-223 ◽

Cited By ~ 1

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.

Download Full-text

Indications and outcomes of radial head excision: A systematic review

Shoulder & Elbow ◽

10.1177/1758573219864305 ◽

2019 ◽

Vol 12 (3) ◽

pp. 193-202 ◽

Cited By ~ 1

Author(s):

Alexandra H Hildebrand ◽

Betty Zhang ◽

Nolan S Horner ◽

Graham King ◽

Moin Khan ◽

...

Keyword(s):

Radial Head ◽

Surgical Techniques ◽

Operative Management ◽

Rheumatoid Disease ◽

Radial Head Fractures ◽

Functional Scores ◽

Post Traumatic ◽

Elbow Pathology ◽

Radial Head Excision

Background Radial head excision has historically been a common surgical procedure for the operative management of radial head fractures and post-traumatic conditions. With recent advances in other surgical techniques, controversy exists regarding its indications. This review evaluates the indications and outcomes of radial head excision in traumatic and non-traumatic elbow pathology. Methods Multiple databases were searched for studies involving radial head excision. Screening and data abstraction were conducted in duplicate. Only studies reporting outcomes for radial head excision were included. Results Twenty-seven studies with 774 radial head excision patients were included. The most common indications involved acute excision of comminuted radial head fractures (n = 347) and rheumatoid arthritis (n = 201). Post-operative functional scores after acute excision were reported to be good to excellent. In the chronic setting of rheumatoid disease, radial head excision resulted in improved range of motion, although pain was not effectively relieved. Discussion Outcomes of radial head excision for acute fracture are good to excellent; however, it should not be performed when concurrent or ligamentous injuries are present. Although some studies compared excision to open reduction and internal fixation or replacement, more data are needed to make proper conclusions. The strength of these conclusions is limited by the quality of included literature.

Download Full-text

Posterolateral Rotatory Instability of the Elbow Following Radial Head Resection

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.d.02829 ◽

2005 ◽

Vol 87 (7) ◽

pp. 1571 ◽

Cited By ~ 46

Author(s):

Jeremy A. Hall

Keyword(s):

Radial Head ◽

Rotatory Instability ◽

Posterolateral Rotatory Instability ◽

Radial Head Resection

Download Full-text

Short- to mid-term outcomes of radial head replacement for complex radial head fractures

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00325 ◽

2020 ◽

Vol 23 (4) ◽

pp. 183-189

Author(s):

Chung-Sin Baek ◽

Beom-Soo Kim ◽

Du-Han Kim ◽

Chul-Hyun Cho

Keyword(s):

Heterotopic Ossification ◽

Radial Head ◽

Elbow Joint ◽

Ulnar Neuropathy ◽

Dash Score ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

The Mean ◽

Quick Dash

Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes.Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7o of flexion, 4.7o of extension, 76.2o of pronation, and 77.5o of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy).Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

Download Full-text

Comparative Study between Surgical Excision of Radial Head Fracture versus Arthroplasty, a Systematic Review of Literature

QJM ◽

10.1093/qjmed/hcab104.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Wael S. Abdel Megied ◽

Ahmed M Khaled ◽

Waleed M Rehan

Keyword(s):

Functional Outcome ◽

Radial Head ◽

Radial Head Fracture ◽

Surgical Techniques ◽

Surgical Excision ◽

Systemic Review ◽

Level Of Evidence ◽

Radial Head Fractures ◽

Type Iv ◽

Radial Head Excision

Abstract Background Radial head fracture is the most frequently diagnosed fracture of the elbow in adults. The radial head is a secondary valgus stabilizer of the joint and it is involved in transmission of axial force load through the elbow during flexion. It is also a varus and external rotatory constraint. Aim of the Work to compare the functional outcome between excision of head radius and Arthroplasty in surgical management of radial head fractures (Mason types III and IV) and to assess the complications of both techniques. Patients and methods This systemic review included subjects suffered comminuted radial head fracture Mason type III or type IV treated by radial head excision or arthroplastyin the last 14 years from 2004 till 2018. Results: The database search identified 152 potentially relevant articles. Abstracts have been analyzed following inclusion and exclusion criteria and a total of 17 papers were selected for the present review. Most of retrospective studies on metal radial head prosthesis have been published in the last ten years in comparison to a lack of studies for radial head excision in the last two decades. Moreover, few articles on comparison of the two surgical techniques have been found. Because of heterogeneity in level of evidence, surgical technique, type of implants, and rehabilitation protocol, we did not perform statistical data analysis. Conclusion No clinical differences between radial head excision and arthroplasty as both methods are considerable regarding complication on long & mid-term follow up and functional outcome assessed by DASH, VAS, MEPS & ROM.

Download Full-text