Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery.RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms.CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

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

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3672-0 ◽

2014 ◽

Vol 472 (7) ◽

pp. 2144-2150 ◽

Cited By ~ 24

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

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Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture

Hand ◽

10.1177/1558944720918358 ◽

2020 ◽

pp. 155894472091835 ◽

Cited By ~ 1

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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Comparison of bipolar and monopolar radial head prostheses in elbow fracture-dislocation

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.10.027 ◽

2020 ◽

Vol 106 (2) ◽

pp. 311-317 ◽

Cited By ~ 2

Author(s):

Maxime Antoni ◽

Jean-François Kempf ◽

Philippe Clavert

Keyword(s):

Radial Head ◽

Fracture Dislocation ◽

Elbow Fracture ◽

Elbow Fracture Dislocation

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

Journal of Clinical Medicine ◽

10.3390/jcm10163488 ◽

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.

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Irreducible anteromedial radial head fracture-dislocation: value of pre-operative magnetic resonance imaging

BJR|case reports ◽

10.1259/bjrcr.20200111 ◽

2020 ◽

pp. 20200111

Author(s):

Lee Kai Lim ◽

Joey Beh

Keyword(s):

Radial Head ◽

Radial Head Fracture ◽

Rare Condition ◽

Fracture Dislocation ◽

Imaging Findings ◽

Mri Imaging ◽

Resonance Imaging ◽

Rare Presentation ◽

Sustained Reduction ◽

Surgical Journal

We describe a case of an anteromedial fracture-dislocation of the radial head in an adult patient, which was initially irreducible using closed means, and remained challenging to reduce despite open surgery. Further advanced CT/MRI revealed entrapment of the radial head due to the interposition of the brachialis tendon posteriorly, thereby preventing sustained reduction. While three other cases of irreducible anteromedial radial head dislocation due to the brachialis tendon have been reported in the English surgical literature, none of the imaging findings have been described in the radiological literature. Only one other case published in a surgical journal briefly demonstrated pre-operative MRI imaging. We would like to share the value of pre-operative MRI in this rare presentation, which would be helpful in diagnosing not only cases with interposition of the brachialis tendon, but potentially other types of soft tissue interposition which also limit closed reduction. To the best of the authors’ knowledge, this would be the first report on the imaging findings in a radiological journal. Awareness of this phenomenon would assist radiologists in the diagnosis and management of this rare condition.

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Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

10.21203/rs.3.rs-101496/v1 ◽

2020 ◽

Author(s):

Shijie Liao ◽

Tiantian Wang ◽

Qian Huang ◽

Yun Liu ◽

Rongbin Lu ◽

...

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Monteggia Fracture ◽

Type I ◽

Ulnar Osteotomy ◽

Group A ◽

The Mean ◽

Group B ◽

Stable Reduction

Abstract PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

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