Functional outcome of radial head replacement in isolated radial head fractures

Background: Proximal radial fractures are common type of fracture around the elbow joint. These commonly occur after an episode of fall on the outstretched arm. These fractures can occur in isolation or with other associated injuries. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring stability of the elbow joint and starting early mobilization. This study will assess functional outcome of radial head replacement in isolated radial head fractures using Mayo elbow performance score.Methods: Over a period of 24 months a total of 18 patients (male 12 and female 6) with isolated radial head fractures were included in the study. All of these patients had MASON type III fractures or above. Radial head replacement arthroplasty was done for irreparable radial head fractures and early mobilization was started. Functional outcome was calculated postoperatively with help of the Mayo elbow score on follow-up at 1, 3 and 6 month interval.Results: On the basis of Mayo elbow performance scores, 13 patients had excellent results; 3 had good results; and 2 had fair results. Mean Mayo elbow score was 88.33 (SD 11.11) after 6 month follow up. None of the patients had elbow instability after radial head replacement. Conclusions: Treatment of irreparable radial head fractures with radial head prosthesis along with soft-tissue reconstruction shows satisfactory results. Early mobilization of the elbow after operation is the key for restoration of elbow range of motion and function.

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Short- to mid-term outcomes of radial head replacement for complex radial head fractures

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00325 ◽

2020 ◽

Vol 23 (4) ◽

pp. 183-189

Author(s):

Chung-Sin Baek ◽

Beom-Soo Kim ◽

Du-Han Kim ◽

Chul-Hyun Cho

Keyword(s):

Heterotopic Ossification ◽

Radial Head ◽

Elbow Joint ◽

Ulnar Neuropathy ◽

Dash Score ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

The Mean ◽

Quick Dash

Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes.Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7o of flexion, 4.7o of extension, 76.2o of pronation, and 77.5o of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy).Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

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

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.305 ◽

2019 ◽

Vol 7 (9) ◽

pp. 1505-1508 ◽

Cited By ~ 1

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.

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Neglected Iatrogenic Elbow Joint Dislocation. Didactic Case Report

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0011.5877 ◽

2018 ◽

Vol 20 (1) ◽

pp. 57-63

Author(s):

Bartłomiej Pawelec ◽

Marcin K. Waśko ◽

Stanisław Pomianowski

Keyword(s):

Case Report ◽

Functional Outcome ◽

Trauma Care ◽

Radial Head ◽

Elbow Joint ◽

Joint Infection ◽

Kirschner Wire ◽

Plaster Cast ◽

Joint Dislocation

We present a case of a neglected dislocation of the elbow joint. A 28-year-old patient suffered elbow joint dislocation with fracture of the radial head after a fall from a considerable height. Following a failed attempt at manual repositioning, the dislocation was reduced surgically and free fragments of the radial head were removed without stabilisation with a Kirschner wire. The joint was immobilised for 6 weeks in an arm-to-hand plaster cast, followed by two weeks during which an elbow joint orthosis with adjustable flexion was worn. The patient then attended rehabilitation. The first follow-up radiograph was obtained as late as 5 months following the operation and revealed a neglected dislocation and periarticular ossifications. Subsequent procedures did not improve limb function and the course was also complicated by a joint infection. The ultimate functional outcome is unsatisfactory. According to the principles of trauma care, all repositioning procedures need to be confirmed with a follow-up radiograph.

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Aseptic Destruction of the Elbow Joint after Radial Head Replacement. Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/15093492.1230555 ◽

2016 ◽

Vol 18 (6) ◽

pp. 583-590

Author(s):

Marcin Błoński ◽

Andrzej Boszczyk ◽

Stanisław Pomianowski ◽

Mariusz Urban

Keyword(s):

Radial Head ◽

Elbow Joint ◽

Radial Head Fractures ◽

Routine Treatment ◽

Radial Head Replacement ◽

Reduction Of Pain ◽

Prosthetic Head ◽

Polyethylene Particles ◽

Excellent Clinical Outcome

Radial head replacement should be a routine treatment in cases of non-reconstructable radial head fractures. With the growing number of radial head arthroplasties, we are going to see more complications related to this procedure. We describe a case of aseptic destruction of the elbow joint, probably related to the release of polyethylene particles from the prosthetic head. Removal of the implant and extensive synovectomy was performed, leading to an excellent clinical outcome with reduction of pain and increase in the range of motion. The clinical improvement was not accompanied by radiographic change.

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Prosthetic replacement of the radial head

Obere Extremität ◽

10.1007/s11678-020-00595-9 ◽

2020 ◽

Vol 15 (4) ◽

pp. 310-315

Author(s):

Kilian Wegmann ◽

Nadine Ott ◽

Tim F. Leschinger ◽

Andreas Harbrecht ◽

Lars P. Müller ◽

...

Keyword(s):

Radial Head ◽

Proximal Part ◽

Study Cohort ◽

Prosthetic Replacement ◽

Specific Patient ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

Press Fit ◽

Significant Difference

Abstract Background Radial head replacement is an established option in patients with comminuted radial head fractures and complex elbow trauma. While studies demonstrated that asymptomatic radiolucencies around the stem are common, the incidence and clinical significance of bone loss at the proximal part of the radius, just distal to the neck of the prosthesis (collar resorption), is unknown. Objectives The aim of this retrospective study was to analyse the incidence of collar resorption after radial head replacement and investigate whether this correlates with specific patient characteristics such as gender, age, indication for index surgery and the size of implant used. Materials and methods The study group consisted of 30 patients (average age 60.1 years) having undergone prosthetic replacement with a monopolar press-fit implant of the radial head at an average follow-up of 23 months. Indications for surgery included trauma sequelae or revision in 16 patients and acute, unreconstructable fractures of the radial head in 14 cases. Symptoms of loosening and revision surgery were recorded. Radiographs were analysed for signs of lucency between the bone and the implant as well as for signs of resorption of bone mass around the neck (section 1). These values were correlated with age, gender, indication for index surgery and size of implant. Results In all, 28/30 (93.3%) prostheses showed proximal osteolysis around the neck of the shaft. Of the 30, one prosthesis presented signs of shaft loosening. The average amount of osteolysis was 8.78% (range 0–26.1%; ±6.0%) of the overall length of the prosthetic shaft (OL). There was no significant difference (p = 0.49) between the amount of resorption in section 1 between the primary fracture cases (8.75 ± 4.5%; range 1.2–15.8%) and the group of secondary implantations due to degeneration or fracture sequelae (8.8 ± 7.2%; range 0–26.1%). Furthermore, the analysis did not reveal any statistically relevant correlations between the amount of neck resorption and the other cohort characteristics (age, gender, size of the components). Conclusions In the study cohort, a high amount of osteolysis/bone resorption was assessed around the neck of the press-fit radial head prosthesis used. However, no significant correlation between collar resorption, patient demographics and indication for index surgery was found at short-term follow-up.

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Ipsilateral Radial Head Dislocation And Proximal One-Third Radial Shaft Fracture In An Adult: A Case Report

The Open Orthopaedics Journal ◽

10.2174/1874325001812010189 ◽

2018 ◽

Vol 12 (1) ◽

pp. 189-195 ◽

Cited By ~ 1

Author(s):

Jagdeep Singh ◽

Anoop Kalia ◽

Anshul Dahuja

Keyword(s):

Functional Outcome ◽

Radial Head ◽

Shaft Fracture ◽

Radial Head Dislocation ◽

Rare Injury ◽

Case Presentation ◽

X Ray ◽

Good Functional Outcome ◽

Traumatic Dislocation

Introduction: Dislocation of the radial head in adults is quite uncommon. A simultaneous dislocation of the radial head with a fracture of ipsilateral shaft radius without any other associated injury is even rare. Case Presentation: We are reporting a case of a young adult male who was operated for proximal one-third radial shaft fracture at some peripheral centre by Open Reduction and Internal Fixation (ORIF), but came to our centre on the fourth post-operative day with complaints of painful restricted movements of the elbow joint. On careful look at the postoperative x-ray, radial head was found to be dislocated. Radial head dislocation was reduced under general anesthesia and at 2 years follow up, patient fracture has fully united having good functional outcome. Conclusion: Traumatic dislocation of radial head with ipsilateral fracture shaft radius is a rare injury in adults and it is very important to timely diagnose it and manage it appropriately in order to give good functional outcome to the patient.

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A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

10.21203/rs.3.rs-112213/v1 ◽

2020 ◽

Author(s):

Xu Gao ◽

Fei Li ◽

Yong-Qiang Sui ◽

Rui Huang ◽

Hai-yu Fan ◽

...

Keyword(s):

Radial Head ◽

Plate Fixation ◽

Visual Analog Scale Score ◽

Reconstruction Technique ◽

Hybrid Technique ◽

Self Assessment ◽

Radial Head Fractures ◽

Mayo Elbow Performance Score ◽

Intramedullary Pinning

Abstract BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

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Treatment of displaced segmental radial-head fractures. Long-term follow-up.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198163050-00004 ◽

1981 ◽

Vol 63 (5) ◽

pp. 712-717 ◽

Cited By ~ 34

Author(s):

G K Miller ◽

D B Drennan ◽

D J Maylahn

Keyword(s):

Radial Head ◽

Radial Head Fractures ◽

Long Term Follow Up

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Elbow Trauma

Musculoskeletal Imaging Volume 1 ◽

10.1093/med/9780190938161.003.0014 ◽

2019 ◽

pp. 62-64

Author(s):

Michael O’Keeffe ◽

Kiran Khursid ◽

Peter L. Munk ◽

Mihra S. Taljanovic

Keyword(s):

Operative Treatment ◽

Radial Head ◽

Preoperative Assessment ◽

The Body ◽

Synovial Joint ◽

Radial Head Fractures ◽

Elbow Trauma ◽

Acute Injuries ◽

Large Joint

Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the second most commonly dislocated large joint of the body. Radiographs are the mainstay in the evaluation of acute injuries and treatment follow-up. CT examination is helpful in preoperative assessment of complex fractures/injuries. All elbow dislocations are initially close reduced and splinted. Further conservative versus operative treatment depends on complexity of injury.

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