scholarly journals Long-Term Outcomes of Radial Head Arthroplasty in Complex Elbow Fracture Dislocation

2021 ◽  
Vol 10 (16) ◽  
pp. 3488
Author(s):  
Alvin Chao-Yu Chen ◽  
You-Hung Cheng ◽  
Chih-Hao Chiu ◽  
Chun-Ying Cheng ◽  
Yi-Sheng Chan
Keyword(s):  
Radial Head ◽  
Pearson Correlation ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Periprosthetic Osteolysis ◽  
Radial Head Arthroplasty ◽  
The Difference ◽  
Elbow Fracture Dislocation

The purpose of the current study was to investigate the long-term outcomes of radial head arthroplasty in complex elbow injuries through radiographic analysis and functional correlation. We evaluated 24 radial head arthroplasties in 24 consecutive patients with complex elbow fracture dislocation. All patients were treated with a single type of modular monopolar prosthesis containing smooth stem in press-fit implantation. Clinical survey using the Mayo Elbow Performance Score (MEPS), self-reported scales of shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the visual analog scale (VAS) at more than 10-year follow-up were reported and compared to 2-year outcomes. Periprosthetic osteolysis was measured in the 10 zones of prosthesis-cortical interface with a modified radiolucency score, which was calibrated by each prosthesis size. Pearson correlation analysis was performed to detect the association between periprosthetic radiolucency and clinical assessment. At the final follow-up, MEPS, QuickDASH score and VAS score averaged 82.5 ± 15, 14.1 ± 14.3 and 1.6 ± 1.2 respectively. A decline in functional status was noted, with decreased mean MEPS and increased mean QuickDASH and VAS scores as compared to the 2-year results while the difference was insignificant. Periprosthetic osteolysis was more prevalent around stem tip of zone 3 and zone 8. The final and 2-year radiolucency scores averaged 7.4 ± 4.2 and 2.6 ± 2.3 respectively with significant difference. Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in MEPS/QuickDASH/VAS was −0.836, 0.517 and 0.464. Progression of periprosthetic osteolysis after postoperative 10 years is more prevalent around the stem tip with moderate to high correlation to clinical outcomes. Sustained follow-up is warranted to justify subsequent surgery for revision or implant removal.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury. Methods A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups. Results In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS. Conclusions With an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution, lateral collateral ligament involvement and time from injury to RHA between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution, lateral collateral ligament involvement and time from injury to RHA between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

scholarly journals Retrospective Cohort Study on Radial Head Arthroplasty Comparing Long-Term Outcomes Between Valgus Type Injury and Fracture Dislocation

2020 ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution, lateral collateral ligament involvement and time from injury to RHA between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

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.

scholarly journals Radial Head Reconstruction in Elbow Fracture-Dislocation: Monopolar or Bipolar Prosthesis?

2014 ◽  
Vol 472 (7) ◽  
pp. 2144-2150 ◽  
Author(s):  
Robert U. Hartzler ◽  
Bernard F. Morrey ◽  
Scott P. Steinmann ◽  
Manuel Llusa-Perez ◽  
Joaquin Sanchez-Sotelo
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Bipolar Prosthesis ◽  
Elbow Fracture Dislocation

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.

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.

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