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

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.

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Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1540-z ◽

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.

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

Swiss Surgery ◽

10.1024/1023-9332.9.6.275 ◽

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.

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Treatment of terrible triad injuries at a mean follow-up of nine years

Shoulder & Elbow ◽

10.1177/1758573218809375 ◽

2018 ◽

Vol 11 (6) ◽

pp. 450-458 ◽

Cited By ~ 2

Author(s):

Ezequiel E Zaidenberg ◽

Mariano O Abrego ◽

Agustin G Donndorff ◽

Jorge G Boretto ◽

Pablo De Carli ◽

...

Keyword(s):

Terrible Triad ◽

Performance Score ◽

Level Of Evidence ◽

Mayo Elbow Performance Score ◽

Flexion Extension ◽

Long Term Follow Up ◽

Radiological Changes ◽

One Year

Background To evaluate the sustainability of the early clinical and radiological outcomes of terrible triad injuries at long-term follow-up. Methods Twelve consecutive patients who underwent fixation of terrible triad injuries with minimum of seven years of follow-up. Functional and radiological outcomes at one year and final follow-up were compared. We assessed Mayo Elbow Performance Score, Quick-Disability of the Arm Shoulder and Hand, and modified-American Shoulder and Elbow Surgeons Scores. Radiological evaluation included Broberg and Morrey classification and Hastings classification for heterotopic ossification. Results The mean age of patients was 55 years, with a median follow-up of 9.3 years. At final evaluation, mean flexion, extension, supination, and pronation were 145°, 6°, 82°, and 80°, respectively; mean Mayo Elbow Performance Score, modified-American Shoulder and Elbow Surgeons Scores, and Quick-Disability of the Arm Shoulder and Hand scores were, respectively, 97, 92, and 4.9 points. There was no statistical difference between early and final follow-up range of motion, Mayo Elbow Performance Score, and Quick-Disability of the Arm Shoulder and Hand. However, radiological changes were observed in 66% of the patients at final follow-up. Two patients underwent reoperation, with final satisfactory results. Conclusion Our results suggested that using a standardized protocol, satisfactory clinical outcomes at early follow-up could be maintained over time. However, early complications and osteoarthritic changes at long-term follow-up can be expected. Level of evidence Therapeutic IV Cases series.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185088 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: Radial head resection yields a good to excellent clinical results in young Indian population with isolated comminuted radial head fractures.

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Clinical Results of Arthroscopic Treatment for Lateral Epicondylitis of Elbow

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.2.187 ◽

1970 ◽

Vol 14 (2) ◽

pp. 187-192 ◽

Cited By ~ 1

Author(s):

Jin Young Park ◽

Jeong Woo Kim ◽

Churl Hong Chun ◽

Hong Je Kang ◽

Jong Yun Kim ◽

...

Keyword(s):

Conservative Treatment ◽

Lateral Epicondylitis ◽

Clinical Results ◽

Loose Body ◽

Arthroscopic Debridement ◽

Performance Score ◽

Analog Scale ◽

Mayo Elbow Performance Score ◽

The Mean

PURPOSE: The purpose of this study was to evaluate the clinical result of arthroscopic debridement with treatment of associated intra-articular lesions in lateral epicondylitis patients who did not response to conservative treatment.METHOD: Between March 2005 and January 2010, 43 patients who were diagnosed with lateral epicondylitis and did not response to conservative treatment over 6 months were selected. The mean age of the patients was 51 years (39~68 years) and the mean follow up period was 36.7 months (18~72 months). Among the 43 patients, 15 were male and 28 were female. They were evaluated by visual analog scale (VAS) and Mayo Elbow Performance Score (MEPS).RESULTS: Intra-articular synovitis was found in 11 cases (26%) and intra-articular loose body was observed in 2 cases. The average VAS score was 7(+/-0.7) preoperatively and decreased to 1(+/-1.0) at last follow up. MEPS was 45(+/-10.2) preoperatively and increased to 93(+/-10.0). At last follow up, 41 of the 43 patients showed satisfaction (MEPS <75) and 2 showed dissatisfaction (MEPS > or =75).CONCLUSION: There was a better outcome at 18 months follow up after arthroscopic debridement with treatment of associated intra-articular lesion in lateral epicondylitis patients who had not responsed to conservative treatment.

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

Materiale Plastice ◽

10.37358/mp.17.2.4837 ◽

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.

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

Hand Surgery ◽

10.1142/s0218810412500049 ◽

2012 ◽

Vol 17 (01) ◽

pp. 25-31 ◽

Cited By ~ 7

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.

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C1 Lateral Mass Fixation

Neurosurgery ◽

10.1227/01.neu.0000365804.75511.e2 ◽

2010 ◽

Vol 66 (suppl_3) ◽

pp. A153-A160 ◽

Cited By ~ 34

Author(s):

Praveen V. Mummaneni ◽

Daniel C. Lu ◽

Sanjay S. Dhall ◽

Valli P. Mummaneni ◽

Dean Chou

Keyword(s):

Neck Pain ◽

Visual Analog Scale ◽

Complication Rate ◽

Pedicle Screws ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Analog Scale ◽

Flexion Extension ◽

Lateral Mass Screws

Abstract OBJECTIVE We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1–C2 constructs, and C1 to mid/low cervical constructs. METHODS We performed a retrospective chart review of 42 consecutive patients who underwent C1 lateral mass fixation by 2 of the authors (PVM and DC). The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1–C2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent OC fusions incorporating C1 screws (2 of which were OC-thoracic constructs). All constructs were combined either with a C2 pars screw (38 patients), C2 translaminar screw (1 patient), or C3 lateral mass screw (3 patients). No C2 pedicle screws were used. Fusion was assessed using flexion-extension x-rays in all patients and computed tomographic scans in selected cases. Clinical outcomes were assessed with preoperative and postoperative visual analog scale neck pain scores and Nurick grading. The nuances of the surgical technique are reviewed, and a surgical video is included. RESULTS Two patients (5%) were lost to follow-up. The mean follow-up for the remaining patients was 2 years. During the follow-up period, there were 4 deaths (none of which were related to the surgery). For patients with follow-up, the visual analog scale neck pain score improved a mean of 3 points after surgery (P < .001). For patients with myelopathy, the Nurick score improved by a mean of 1 grade after surgery (P < .001). The postoperative complication rate was 12%. The complication rate was 38% in OC constructs, 17% in C1 to mid/low cervical constructs, and 0% for C1–C2 construct cases. Patients with OC constructs had the statistically highest rate of complications (P < .001). Patients with C1 to mid/low cervical constructs had more complications than those with C1–C2 constructs (P < .001). Of the 42 cases, there were 3 pseudoarthroses (1 in an OC case, 1 in a C1 to midcervical construct, and 1 in a C1–C2 construct). OC constructs had the highest risk of pseudoarthrosis (13%) (P < .001). CONCLUSION Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.

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Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185056 ◽

2018 ◽

Vol 5 (1) ◽

pp. 55

Author(s):

Subraya B. Kuloor ◽

Abdul J. Shareef ◽

Anupam Sudeep

Keyword(s):

Elbow Dislocation ◽

Medial Epicondyle ◽

Performance Score ◽

Mayo Elbow Performance Score ◽

Surgical Methods ◽

Flexion Extension ◽

Surgical Fixation ◽

K Wires ◽

Dislocation Group ◽

Medial Epicondyle Fracture

Background: Medial epicondyle fracture is a common elbow injury in children. It is associated with elbow dislocation in many cases. Treatment of displaced medial epicondyle fracture with and without elbow dislocation is a debated topic. Surgical and non surgical methods are practiced with variable results.Methods: Our study was a prospective study of medial epicondyle fractures treated by surgical fixation with k wires. We studied total of 24 cases out of which 15 had elbow dislocation. The study period was from 2012 to 2015 and indications for surgery were displacement more than 5 mm, elbow instability, incarceration of fragment, ulnar nerve irritation. Open reduction and internal fixation with K wire done. We used joystick method while reducing the fragment with k wire which was a great help. We assessed the cases using mayo elbow performance score.Results: Our study yielded excellent results in 92% of patients (mayo elbow performance score >90). There was no major difference in clinical outcome between two groups of patients. Complications like instability and non-union not seen following surgical fixation with K wires. The mean loss of flexion, extension, supination, and pronation was 4, 5, 3 and 2 degrees respectively with elbow dislocation group and 2, 3, 1, 1 in without dislocation group. Pre op instability seen in 54% patients was absent in follow up period. Stiffness was more in elbow dislocation group but overall performance was almost equal.Conclusions: Surgical fixation of medial epicondyle fractures yields excellent results and may be advisable when indicated.

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

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2016-175-5-41-45 ◽

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.

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