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.

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 Operative Management of Unstable Radial Head Fractures in a Young Active Population

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 473-480 ◽  
Author(s):  
Nicholas Kusnezov ◽  
Emmanuel Eisenstein ◽  
John C. Dunn ◽  
Austin Fares ◽  
Justin Mitchell ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Operative Management ◽  
Elbow Fracture ◽  
Complication Rates ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Increased Risk ◽  
Ligamentous Repair

Background: Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands. Methods: A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures. Results: A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05). Conclusions: Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.

The non-operative management of radial head fractures: a randomized trial of three treatments

Injury ◽  
1994 ◽  
Vol 25 (3) ◽  
pp. 165-167 ◽  
Author(s):  
J. Unsworth-White ◽  
R. Koka ◽  
M. Churchill ◽  
J.C. D'Arcy ◽  
S.E. James
Keyword(s):  
Randomized Trial ◽  
Radial Head ◽  
Operative Management ◽  
Radial Head Fractures ◽  
Non Operative Management

scholarly journals Management of post-traumatic elbow instability after failed radial head excision: A case report

2017 ◽  
Vol 20 (1) ◽  
pp. 59-62
Author(s):  
Georgios Touloupakis ◽  
Emmanouil Theodorakis ◽  
Fabio Favetti ◽  
Massimiliano Nannerini
Keyword(s):  
Case Report ◽  
Radial Head ◽  
Elbow Instability ◽  
Post Traumatic ◽  
Radial Head Excision

scholarly journals Surgical Treatment of Radial Head Fractures: Review of Literature.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Edvin Selmani ◽  
Agron Dogjani
Keyword(s):  
Radial Head ◽  
Functional Outcomes ◽  
Treatment Decision ◽  
Functional Score ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Radial Head Fractures ◽  
Search Terms ◽  
Functional Scores ◽  
Type 3

The aim of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. Material and methods: A comprehensive study of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed. Results: Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion. Conclusion: Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision-making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution.

scholarly journals Trends in Management of Radial Head and Olecranon Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 239-247 ◽  
Author(s):  
Matthew Motisi ◽  
Jennifer Kurowicki ◽  
Derek D. Berglund ◽  
Jacob J. Triplet ◽  
Shanell Disla ◽  
...  
Keyword(s):  
Radial Head ◽  
Retrospective Review ◽  
Surgical Techniques ◽  
Operative Management ◽  
Open Reduction Internal Fixation ◽  
Significant Trend ◽  
Office Visits ◽  
Radial Head Arthroplasty ◽  
Non Operative Management ◽  
Olecranon Fractures

Background: Advancement in surgical techniques and implants has improved the ability to manage radial head and olecranon fractures. However, trends in management of these fractures are largely unstudied. Objective: This purpose of this study is to evaluate management trends for these common fractures. Methods: A retrospective review of a comprehensive Humana database was performed using Pearl Diver supercomputer (Warsaw, IN, USA) for radial head and neck (RHNF) and olecranon fractures (OF) between 2007 and 2014. Treatment methods including open reduction internal fixation (ORIF), radial head arthroplasty (RHA), and non-operative treatment were reviewed. Total reported incidence of office visits and utilization of each treatment modality were investigated. Sub-analysis with stratification by age 15-74 and greater than 75-years was performed for OF. Results: A total of 10,609 OF and 20,400 RHNF were identified between 2007 and 2014. A significant trend increase in the annual incidence of RHNF (266 cases/year, p<0.001) and OF (133.9 cases/year, p=0.001) was observed. A significant trend increase in annual percent utilization of RHA (0.22% per year, p=0.011) and a significant trend decrease in the annual percent utilization of ORIF (-1.0% per year, p=0.004) and non-operative management (-0.53% per year, p=0.046) was observed for RHNF. A significant trend increase was observed in percent utilization (0.40% per year, p=0.022) for OF non-operative management, especially in patients over 75 years (66% per year, p=0.034). Conclusion: The percentage of patients being treated with RHA is increasing. Non-operative management of OF has increased, specifically in the patients who are over 75 years.

scholarly journals Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study

2019 ◽  
Vol 7 (9) ◽  
pp. 1505-1508 ◽  
Author(s):  
Ayush Kumar Singh ◽  
Aswini Jidge ◽  
Ujwal Ramteke ◽  
Nivedhitha Venkateswaran ◽  
Hemlata Rokade ◽  
...  
Keyword(s):  
Comparative Study ◽  
Radial Head ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Prospective Comparative Study ◽  
The Difference ◽  
Type Of Injury ◽  
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.

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.

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