Complications, Reoperations, and Long-Term Outcomes after Open Reduction Internal Fixation of Mason Classification Type II and Type III Radial Head Fractures

2021 ◽  
Author(s):  
Dafang Zhang ◽  
George S. M. Dyer ◽  
Brandon E. Earp ◽  
Philip Blazar
Keyword(s):  
Radial Head ◽  
Open Reduction Internal Fixation ◽  
Type Ii ◽  
Long Term Outcomes ◽  
Radial Head Fractures ◽  
Mason Classification ◽  
Average Patient ◽  
Classification Type

Abstract Introduction The objectives of this study were to assess long-term outcomes, complications, and reoperations after open reduction internal fixation (ORIF) of radial head fractures. Materials and Methods 35 adult patients, who underwent ORIF of an isolated, displaced radial head fracture without elbow instability (Mason classification type II or III) at two tertiary care referral centers from 2000 to 2017, were identified. Patient satisfaction, pain, and QuickDASH scores were assessed by telephone follow-up at median 12.9 years. Results The mean age of the 35 patients in our study was 39 years, and 54% were women. The median length of clinical follow-up was 175 days. Postoperative complications occurred in 54% of patients, and reoperations in 23% of patients. Multivariable logistic regression identified fixation with plate and screws versus screws alone as a risk factor for complications and reoperations. The long-term telephone follow-up response rate was 54%. At 13-year median follow-up, the average patient satisfaction was 9.6/10, the average patient-reported pain was 0.7/10, and the average QuickDASH score was 10.5. Conclusion The long-term outcomes of ORIF of Mason classification type II and III radial head fractures are favorable; however, rates of complication and reoperation are notable and may be higher with plate-and-screw fixation.

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.

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

2020 ◽  
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 nine 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, lateral collateral ligament involvement and time from injury to RHA 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 nine 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.

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

2020 ◽  
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 nine 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, lateral collateral ligament involvement and time from injury to RHA 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 nine 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.

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

2020 ◽  
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 nine 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 nine 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.

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

2020 ◽  
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 nine 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 nine 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.

scholarly journals Retrospective Cohort Study on Radial Head Arthroplasty Comparing Long-Term Outcomes Between Valgus Type Injury and Fracture Dislocation

2020 ◽  
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 nine 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, lateral collateral ligament involvement and time from injury to RHA 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 nine 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.

Surgical treatment of the radial head is crucial for the outcome in terrible triad injuries of the elbow

2020 ◽  
Vol 102-B (12) ◽  
pp. 1620-1628
Author(s):  
Alexander Klug ◽  
Angela Nagy ◽  
Yves Gramlich ◽  
Reinhard Hoffmann
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Independent Effect ◽  
Type I ◽  
Dash Score ◽  
Type Ii ◽  
Terrible Triad ◽  
Radial Head Fractures ◽  
Type Iii

Aims To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Methods Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible. Results At follow-up the mean MEPS was 87.1 (20 to 100); mean OES, 36.9 (6 to 48); and mean DASH score, 18.6 (0 to 90). Mean movement was 118° (30° to 150°) for extension to flexion and 162° (90° to 180°) for pronation to supination. The overall reoperation rate was 24%, with nine ORIF, ten RHA, and two patients without treatment to the radial head needing surgical revision. When treated with RHA, Mason type III fractures exhibited significantly inferior outcomes. Suboptimal results were also identified in patients with degenerative or heterotopic changes on their latest radiograph. In contrast, more favourable outcomes were detected in patients with successful radial head reconstruction after Mason type III fractures. Conclusion Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most TTIs. Although some bias in treatment allocation, with more severe injuries assigned to RHA, cannot be completely omitted, treatment of radial head fractures may have an independent effect on outcome, as patients subjected to RHA showed significantly inferior results compared to those subjected to reconstruction, in terms of elbow function, incidence of arthrosis, and postoperative complications. As RHA showed no apparent advantage in Mason type III injuries between the two treatment groups, we recommend reconstruction, providing stable fixation can be achieved. Cite this article: Bone Joint J 2020;102-B(12):1620–1628.

Sign in / Sign up

Export Citation Format

Share Document