Osteosynthesis of Combined Injuries of the Capitellum humeri and the Radial Head

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 275-282
Author(s):  
Ott ◽  
Rikli ◽  
Babst
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Performance Score ◽  
Anatomische Rekonstruktion ◽  
Mayo Elbow Performance Score ◽  
Capitulum Humeri ◽  
Combined Injuries

Einleitung: Kombinierte Verletzungen des Capitulum humeri und des Radiusköpfchens sind selten. Meist sind neben den osteocartilaginären Schäden am Gelenk auch Verletzungen der Kollateralbänder assoziiert. Behandlungsempfehlungen für diese seltenen schwerwiegenden Ellenbogenverletzungen fehlen. Studientyp: In einer retrospektiven Analyse werden fünf Fälle untersucht, bei denen die osteocartilaginären Verletzungen des Capitulum humeri durch den gleichen Zugang, der zur Versorgung des Radiusköpfchens verwendet wurde, versorgt wurden. Die Osteosynthese erfolgte mit Mini-Titanimplantaten z.T. kombiniert mit resorbierbaren Pins. Patienten und Methode: Zwischen 1996-1999 wurden fünf Patienten (vier Männer, eine Frau) mit einer Kombinationsverletzung von Radiuskopf und Capitulum humeri operativ stabilisiert. Das Durchschnittsalter beträgt 34 Jahre (31-40 Jahre). Alle Frakturen wurden über einen direkten radialen Zugang mittels 1.5mm oder 2.0mm Zugschrauben, zum Teil mit resorbierbaren Pins stabilisiert. Anschliessend wurden die Patienten radiologisch und klinisch gemäss dem Mayo-elbow-performance Score beurteilt. Resultate: Alle Patienten konnten persönlich durch einen nicht in die Initialtherapie involvierten Untersucher nach durchschnittlich 12.8 Monaten (8-24 Monate) nachuntersucht werden. 4/5 Patienten konnten bezüglich ihrer subjektiven Einschätzung befragt werden. Radiologische Zeichen einer Nekrose des Capitulum humeri oder Arthrosezeichen fanden sich nicht. Bei drei Patienten fanden sich periartikuläre Verkalkungen. Der range of motion beträgt durchschnittlich 124 Grad (Extension 5-30 Grad, Flexion 110-145 Grad) in drei von fünf Fällen waren Sekundäreingriffe zu Mobilitätsverbesserung nötig. Der Mayo-elbow-performance Score beträgt im Mittel 85 Punkte (range 70-100 Punkte). Schlussfolgerung: Die direkte Verschraubung mit Miniimplantaten zum Teil in Kombination mit resorbierbaren Pins ermöglicht eine stabile anatomische Rekonstruktion des Capitulum humeri durch den gleichen Zugang wie er für die Stabilisierung des Radiusköpfchens notwendig ist. Die transartikuläre Fixation der kleinen Schalenfragmente des Capitulum humeri erlaubt eine sichere interfragmentäre Kompression und damit eine frühfunktionelle Rehabilitation. Sekundäreingriffe zur Verbesserung der Gelenkbeweglichkeit waren in drei von fünf Fällen nötig.

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 Is radial head resection a menace for the clinical outcomes of the elbow for comminuted radial head fractures?

2018 ◽  
Vol 5 (1) ◽  
pp. 70
Author(s):  
B. Mohan Choudhary ◽  
S. Pradeesh Kiswanth ◽  
R. Dorai Kumar
Keyword(s):  
Clinical Outcomes ◽  
Radial Head ◽  
Indian Population ◽  
Clinical Results ◽  
Performance Score ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Elbow Fractures ◽  
Radial Head Resection ◽  
Excellent Functional Outcome

<p class="abstract"><strong>Background:</strong> Radial head fractures are about 20% of all the elbow fractures. Comminuted radial head fractures can cause great impairment on upper extremity functional status. In older times, radial head resection was the treatment of choice for comminuted radial head fractures. Recently, radial head implant arthroplasty has become popular for fractures that could not be fixed. In this study, we assess the clinical outcomes in patients who underwent Radial head resection in Indian population of the productive age group.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 15 patients of age more than 18 and less than 50 years of age, who have underwent radial head resection for Mason type III radial head fractures. Outcomes were evaluated according to the Mayo Elbow Performance Score at 3 months, 6 months and at 1 year follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that 80% of our patients were pain free at the end of 1 year and 20% had minimal to moderate pain. About 80% of our patients regained their “functional range” of movements. 12 of our patients had a stable elbow joint and only 3 patients complained of minimal to moderate instability after the procedure. 87% of our patients had a good to excellent functional outcome at the end. The mean Mayo elbow performance score was 92.3 which is graded as excellent and did not have any significant complications to hinder the clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Radial head resection yields a good to excellent clinical results in young Indian population with isolated comminuted radial head fractures.</p>

scholarly journals Bipolar Polyethylene Radial Head Artroplasty in Posttraumatic Unstable Elbows Prosthetic design and clinical results

2017 ◽  
Vol 54 (2) ◽  
pp. 298-301
Author(s):  
Paul Dan Sirbu ◽  
Razvan Tudor ◽  
Grigore Berea ◽  
Andrei Scripcaru ◽  
Bogdan Ciubara ◽  
...  
Keyword(s):  
Radial Head ◽  
Functional Results ◽  
Clinical Results ◽  
Implantation Technique ◽  
Prosthetic Design ◽  
Performance Score ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Comminuted Fractures ◽  
Joint Tracking

The purpose of this experimental study is to present the design and biomechanical characteristics of bipolar polyethylene radial head prostheses type KPS (CHM â Poland), as well as to evaluate their use in comminuted fractures type Mason III associated with ligament injuries. We retrospectively evaluated 7 patients with 7 complex radial head fractures with an average age of 38.5 years. The prostheses were implanted through a lateral Kocher approach and patients immediately began the rehabilitation of the elbow. The functional results according to the MEPS score (Mayo Elbow Performance Score) were excellent in 3 cases and good in 4 cases, without stem loosening or residual instability of the elbow. Due to the overwhelming advantages of this bipolar prosthesis (better joint tracking and easier implantation technique) and its very good functional results, the authors recommend this type of arthroplasty in posttraumatic elbow instability.

PREVENTION OF INSTABILITY OF THE PROXIMAL END OF THE RADIUS AFTER RADIAL HEAD RESECTION USING AN ANCONEUS MUSCLE FLAP

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 25-31 ◽  
Author(s):  
Kinya Nishida ◽  
Norimasa Iwasaki ◽  
Tadanao Funakoshi ◽  
Makoto Motomiya ◽  
Akio Minami
Keyword(s):  
Radial Head ◽  
Muscle Flap ◽  
Performance Score ◽  
Radiographic Findings ◽  
Mayo Elbow Performance Score ◽  
Proximal Radius ◽  
Radial Head Resection ◽  
The Mean ◽  
Stabilization Technique

Resection of the radial head frequently causes instability of the proximal end of the radius. To prevent this instability, we performed a stabilization technique using an anconeus muscle flap. Since 2003, six patients with radiocapitellar joint dysfunction have been treated with radial head resection combined with stabilizing its proximal end using an anconeus muscle flap. At a mean follow-up of 51 months, all patients were free from elbow pain and the mean Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand score significantly improved. Radiographic findings showed no apparent instability of the proximal radius. The anconeus is useful as a reliable muscle flap for preventing instability of the proximal radius after a radial head resection. This procedure does not require any microvascular techniques and makes it possible to apply a pedicled muscle flap using a relatively simple technique without any considerable risks of elbow dysfunction.

Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases

2020 ◽  
pp. 175857321989785
Author(s):  
Shai Factor ◽  
Dani Rotman ◽  
Tamir Pritsch ◽  
Raviv Allon ◽  
Daniel Tordjman ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Radial Head ◽  
Performance Score ◽  
Interposition Arthroplasty ◽  
Analog Scale ◽  
Unique Problem ◽  
Mayo Elbow Performance Score ◽  
Ulnar Shortening Osteotomy ◽  
Flexion Extension ◽  
Radial Head Excision

Background Severe radiocapitellar pathologies represent a unique problem in the pediatric population, as radial head excision can lead to substantial long-term complications. We present a case series of four pediatric patients treated by a novel technique—radial head excision followed by Achilles allograft interposition arthroplasty. Methods Four children (ages 12–15 years) are described. Their clinical and radiographic outcomes were assessed by a visual analog scale, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire, grip strength, and range of motion. Results At a mean follow-up of two years, the average flexion-extension arc of motion improved from 107° to 131°, and the rotation arc improved from 100° to 154°. The average visual analog scale, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand scores were 2, 92.5, and 11.5, respectively. Two patients required subsequent additional procedures—manipulation under anesthesia and ulnar shortening osteotomy. Proximal migration of the radius was observed in three out of the four patients. Discussion Combined radial head excision and Achilles allograft interposition arthroplasty represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with good results in terms of clinical and functional outcomes as well as patient satisfaction in the short-medium term.

scholarly journals APPLICATION OF MINI-PLATES AND MINI-SCREWS IN TREATMENT OF PATIENTS WITH RADIAL HEAD FRACTURES

2016 ◽  
Vol 175 (5) ◽  
pp. 41-45
Author(s):  
V. A. Neverov ◽  
K. S. Egorov
Keyword(s):  
Radial Head ◽  
Functional Result ◽  
Early Postoperative Period ◽  
Performance Score ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Advantages And Disadvantages ◽  
Analysis Of Results ◽  
Methods Of Treatment ◽  
Radial Bone

An article presents an experience of application of compression headless mini-screws (Gerbert’s screws) and mini-plates in treatment of radial head fractures. The authors showed advantages and disadvantages of given methods of treatment in 41 patients. Gerbert’s screws were used in 32 cases and mini-plates were applied in 9 patients. Mini-plates in combination with Gerbert’s screws were used in 4 patients. There weren’t noted complications in early postoperative period. Patients (27-84%) with Gerbert’s screws were followed up in terms more than 6 months. Mean score was 91 according to the scale of Mayo Elbow Performance Score. Results of application of mini-plates were followed up in terms more than 6 months in 7 (77%) patients. Mean score of Mayo Elbow Performance Score consisted of 72. Based on the analysis of results, the authors concluded that the application of mini-screws in radial head fractures allowed doctors to obtain a good anatomical and functional result. Osteosynthesis by mini-plates didn’t always support the secure fixation of all fractures due to strictly given positioning on the head of radial bone. In case of osteosynthesis of splintered fractures of Mason type III, it should be reasonable to combine mini-plates and Gerbert’s screws.

scholarly journals Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

2020 ◽  
Vol 6 (6) ◽  
pp. 1215
Author(s):  
Faisal S. Mohammed ◽  
Akshay B. Ingale
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Distal Humerus Fracture ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Locking Compression Plates ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Extensor Lag

<p><strong>Background:</strong> Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type  13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.</p><p><strong>Methods:</strong> Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.</p><p><strong>Results:</strong> Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.</p><p><strong>Conclusions:</strong> Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.</p>

scholarly journals THE TREATMENT OF EXTRA- AND INTRA-ARTICULAR FRACTURES THE DISTAL HUMERUS

2010 ◽  
Vol 16 (3) ◽  
pp. 96-102
Author(s):  
V. V. Klyuchevsky ◽  
Hassan Ben El Hafi
Keyword(s):  
Soft Tissues ◽  
Functional Results ◽  
Distal Humerus ◽  
Distal Segment ◽  
Rigid Fixation ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Articular Fractures ◽  
Active Mobilization ◽  
Violent Acts

From 2005 to 2009 we treated 112 patients with fractures of distal segment of the humerus, 83 (74,10%) of them were injured when falling from the height of its own growth, 8 (7,14%) - in an accident, 6 (5,35%) - a fall from a height, 13 (11,6%) - in sports, and two - as a result of violent acts. In 97 (87%) cases the fractures were closed, in 15 (13%) - open. 19 patients were treated conservatively and 93 - operatively. Functional results were evaluated using the Mayo elbow performance score (MEPS) in 78,37% of patients. Results of the conservative method: excellent and good - 46,66%, and in all patients with type A without displacement - in 100%. The fair results - in 33% and the poor in 20% - with type В and C. The results of operative treatment: excellent and good - 90,41%, the fair results - in 9,58%, no poor results. Initial prevent the oedema and bleeding into joints and soft tissues, adequate rigid fixation of fractures with the maximal restoration of the elbow joint congruent without additional immobilization and early active mobilization is essential to prevent the elbow stiffness and achieve a good outcomes.

scholarly journals Rotura aguda de bíceps distal: reparación mediante abordaje único anterior y dispositivo de anclaje cortical

2021 ◽  
Vol 78 (1) ◽  
pp. 68-73
Author(s):  
Cristian Pinilla-Gracia ◽  
Alberto Hernández-Fernández ◽  
Luis Rodríguez-Nogué ◽  
Elena Masa Lasheras ◽  
Isaias Garrido Santamaría
Keyword(s):  
Performance Score ◽  
Mayo Elbow Performance Score

Antecedentes: La rotura del tendón distal del bíceps braquial es una patología con una incidencia creciente, que puede ocasionar importantes alteraciones funcionales. Cuando la rotura es completa y el paciente activo, el tratamiento quirúrgico es de elección. Material y método: Varón de 47 años con dolor intenso y súbito en la fosa antecubital izquierda mientras levantaba peso. A la exploración, impotencia para la flexión y supinación activa del brazo izquierdo con pérdida de la silueta del bíceps braquial. La ecografía confirma el diagnóstico de rotura completa del tendón distal del bíceps braquial. Se decide tratamiento quirúrgico, realizando un abordaje único anterior  y reinsertando el tendón en su “footprint” radial con ayuda de un dispositivo de anclaje cortical. Resultados: A los 12 meses, el paciente presenta flexo-extensión y prono-supinación completa, sin encontrar dificultades para realizar las actividades de su vida diaria y laboral, con puntación de 100 puntos en el Mayo Elbow Performance Score (MEPS). Conclusión: La rotura del bíceps distal es una lesión típica de pacientes activos con una incidencia creciente. Aunque no se han evidenciado diferencias significativas entre las distintas opciones de reparación, en nuestra experiencia la utilización de dispositivos de anclaje cortical con un abordaje único anterior aporta unos resultados muy satisfactorios.

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.

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