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

Hand ◽  
2020 ◽  
pp. 155894472091835 ◽  
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.

KPS Bipolar Radial Head Arthroplasty – Polyethylene Head Replacement with a Metal-covered Head. Case Study

2018 ◽  
Vol 20 (3) ◽  
pp. 229-237
Author(s):  
Kamila Malesa ◽  
Mariusz Urban ◽  
Dariusz Michalik ◽  
Stanisław Pomianowski
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Surgical Procedures ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Therapeutic Results

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been ob­tained, this procedure, like any other surgical procedures, may be associated with severe complications, includ­ing contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has al­ways been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

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 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 Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

2018 ◽  
Vol 21 (4) ◽  
pp. 234-239
Author(s):  
Hee Seok Yang ◽  
Jeong Woo Kim ◽  
Sung Hyun Lee ◽  
Byung Min Yoo
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Articular Surface ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Group A ◽  
Elbow Fracture Dislocation ◽  
Group B ◽  
Comminuted Radial Head Fracture ◽  
Partial Excision

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery.RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms.CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: a retrospective study of 40 patients

2020 ◽  
Author(s):  
Liang Guo ◽  
睿夫 li ◽  
Xuhui Yang ◽  
Chao Yu ◽  
Fei Gui
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fracture ◽  
Treatment Plan ◽  
Young Patients ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Metallic Implants ◽  
Radial Head Resection

Abstract Background The treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation are hard to achieve. Common techniques include radial head resection and arthroplasty. Both methods have characteristic complications. The present study aims to demonstrate the feasibility of treating unreducible radial head fractures with absorbable polylactide pins. Methods A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic implants. Patients receiving both modalities were followed-up for a mean of 15 months (standard deviation [SD]: 2.6). Radiographic analysis was conducted 2, 30, 60 and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test. Result All fractures healed successfully. The data shows no statistical difference between the polylactide and metallic implant groups. Complications were infrequent and did not cause disability. All patients were satisfied with the surgical outcomes. Conclusion Polylactide pins can feasibly treat severely comminuted radial head fractures which are normally considered unreducible. The outcomes were similar to those of metallic implants. This technique provides an optional treatment plan in addition to resection and arthroplasty, especially for young patients that refuse that form of treatment.

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