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

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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Prospective comparative study of short term functional outcomes of radial head excision arthroplasty and radial head replacement arthroplasty in radial head fracture

National Journal of Clinical Orthopaedics ◽

10.33545/orthor.2019.v3.i1c.29 ◽

2019 ◽

Vol 3 (1) ◽

pp. 147-153

Author(s):

Dr. Madhukar ◽

Dr. Vinoth KR ◽

Dr. Vijay Narasimman Reddy

Keyword(s):

Comparative Study ◽

Radial Head ◽

Functional Outcomes ◽

Radial Head Fracture ◽

Short Term ◽

Radial Head Replacement ◽

Replacement Arthroplasty ◽

Prospective Comparative Study ◽

Excision Arthroplasty ◽

Radial Head Excision

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Radial head fractures

Shoulder & Elbow ◽

10.1177/1758573219876921 ◽

2019 ◽

Vol 12 (3) ◽

pp. 212-223 ◽

Cited By ~ 1

Author(s):

RP van Riet ◽

MPJ van den Bekerom ◽

A Van Tongel ◽

C Spross ◽

R Barco ◽

...

Keyword(s):

Radial Head ◽

Long Term Results ◽

Valgus Stress ◽

Proximal Ulna ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

Treatment Type ◽

Radial Head Resection ◽

Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03767-4 ◽

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.

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

Hand ◽

10.1177/1558944717715136 ◽

2017 ◽

Vol 13 (4) ◽

pp. 473-480 ◽

Cited By ~ 4

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.

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

10.21203/rs.3.rs-33672/v2 ◽

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.

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

10.21203/rs.3.rs-33672/v3 ◽

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

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Radial Head Arthroplasty: Does Ligaments Repair Influence Outcomes? A Minimum Two Years Follow-Up Radiographic Multi-Center Study

10.21203/rs.3.rs-418402/v1 ◽

2021 ◽

Author(s):

Cristina Galavotti ◽

Sara Padovani ◽

Alessandro Nosenzo ◽

Margherita Menozzi ◽

Pietro Maniscalco ◽

...

Keyword(s):

Radial Head ◽

Revision Rate ◽

Radial Head Fracture ◽

Degenerative Changes ◽

Annular Ligament ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Multi Center Study ◽

Center Study

Abstract Purpose: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic-degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two-years follow up. The secondary aim was to delineate a trend profile of RHA implants.Methods: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients’ charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. Results: In six years 124 RHA were implanted (74 Female, 50 Male, mean age 56). The main diagnoses were: terrible-triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the two groups, nevertheless the cohort of patients that underwent ligaments repair had a lower revision rate in comparison to the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%.Conclusion:This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at mid-term follow-up.

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Extracorporeal Reconstruction of the Radial Head

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.2399 ◽

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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