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

QJM ◽  
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.

scholarly journals Indications and outcomes of radial head excision: A systematic review

2019 ◽  
Vol 12 (3) ◽  
pp. 193-202 ◽  
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.

scholarly journals Extracorporeal Reconstruction of the Radial Head

2021 ◽  
Author(s):  
Kow Ren Yi ◽  
Zaharul Azri Mustapha Zakaria ◽  
Ruben Jaya Kumar ◽  
Low Chooi Leng ◽  
Khairul Nizam Siron Baharom
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Removal Rate ◽  
Viable Option ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Type Iii ◽  
Elbow Function ◽  
Radial Head Excision

Radial head fractures are common in adults. The radial head acts as an important stabilizer of the radius, especially during the forearm pronation and supination. Surgical treatment of Mason type III fracture of the radial head includes radial head excision, radial head replacement and open reduction and internal fixation. For patients treated with radial head excision, the radius might migrate proximally, causing complications such as chronic pain at the wrist, forearm, and elbow. On the other hand, radial head arthroplasty is associated with a high revision and removal rate. Hence, openreduction and internal fixation are preferred when feasible. This is technically demanding due to the severe displacement of the radial head fragments and limited surgical space. Mr K, a 30-year-old manual worker sustained a closed right radial head fracture Mason type III after an alleged fall. The radial head was displaced anteriorly. Intra-operatively, the radial headpieces were retrieved and were reconstructed extracorporeal and fixed with a miniplate. The patient subsequently recovered with good function. The new technique of extracorporeal reconstruction of the radial head offers a viable option to the surgeon with similar, or even better, outcomes in terms of elbow function.

scholarly journals Involvement of the proximal radial ulnar joint in partial radial head fractures: a novel three-dimensional computed tomography scan evaluation method

2017 ◽  
Vol 11 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Anne Couture ◽  
Jonah Hébert-Davies ◽  
Julien Chapleau ◽  
G. Yves Laflamme ◽  
Emilie Sandman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radial Head ◽  
Evaluation Method ◽  
Radial Head Fracture ◽  
Geometric Model ◽  
Observer Agreement ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Radial Head Fractures ◽  
Radial Tuberosity

Background Partial radial head fractures (PRHF) can involve the proximal radioulnar joint (PRUJ) or be restricted to the ‘safe zone’ (SZ) during forearm rotation. The objective of the present study was to develop an assessment method for PRUJ involvement in radial head fractures using axial computed tomography (CT) scans. Methods The area of the radial head in contact with the PRUJ zone was identified, and defined on 18 cadaveric elbows CT scans; the quantitative relationship between PRUJ zone and radial tuberosity was established. Then, four evaluators validated it on PRHF CT scan axial views, classifying the fractures as involving the PRUJ or not. Results Using the radial tuberosity as the 0° of a 360° circle, the SZ was within 108° to 212° clockwise for a right elbow and counter clockwise for the left elbow. Fifty-five consecutive (30 men, 25 women, mean age of 49 years) partial radial head fracture CT scans were classified: four in the SZ only, three in the PRUJ zone and 48 in both the PRUJ and SZ. The kappa for the inter- and intra-observer agreement was 0.517 and 0.881, respectively. Conclusions Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. Level of evidence Retrospective basic science study. Level III: anatomic study, imaging

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.

Radius and Ulna Trauma

2019 ◽  
pp. 65-67
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Radial Head ◽  
Distal Radioulnar Joint ◽  
Monteggia Fracture ◽  
Radial Head Fractures ◽  
Type Iv ◽  
Ulnar Fracture ◽  
Fracture Dislocations ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Essex Lopresti

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

scholarly journals Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study

2017 ◽  
Vol 5 (4) ◽  
pp. 266-272 ◽  
Author(s):  
Pradeep Kumar Meena ◽  
◽  
Sahil Gaba ◽  
Sandesh Bobade ◽  
Rajendra Verma ◽  
...  
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Radial Head ◽  
Short Term ◽  
Radial Head Fractures

INTRA-ARTICULAR RADIAL HEAD FRACTURE IN A CHILD WITH AN OPEN PHYSIS: A CASE REPORT

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 159-163
Author(s):  
Koji Moriya ◽  
Yutaka Maki ◽  
Hisao Kouda
Keyword(s):  
Case Report ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Articular Surface ◽  
Type Iii ◽  
Type Iv ◽  
Open Physis ◽  
Salter Harris

Fractures of the proximal end of the radius in children are uncommon. A case of fracture through the articular surface of the radial head (Salter–Harris type IV) in a 12-year-old boy is presented. Our paper recommends bone peg fixation in the treatment of Salter–Harris (S–H) type III or IV injuries in nearly skeletally mature.

scholarly journals Radial Head Resection versus Arthroplasty in Unrepairable Comminuted Fractures Mason Type III and Type IV: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Francesco Catellani ◽  
Francesca De Caro ◽  
Carlo F. De Biase ◽  
Vincenzo R. Perrino ◽  
Luca Usai ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Stability Range ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Type Iii ◽  
Type Iv ◽  
Radial Head Resection ◽  
Comminuted Fractures ◽  
Poor Outcomes

Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.

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