scholarly journals Results of radial head resection after Mason type 3 or 4 fracture of the elbow

2020 ◽  
Vol 23 (3) ◽  
pp. 131-135
Author(s):  
Ferdinand Nyankoue Mebouinz ◽  
Amadou Kasse ◽  
Mouhamadou Habib Sy
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Terrible Triad ◽  
Mean Values ◽  
Radial Head Resection ◽  
Elbow Function ◽  
The Mean ◽  
Comminuted Radial Head Fracture ◽  
Type 3

Background: Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods: A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results: Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions: Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.

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

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.

Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study

2018 ◽  
Vol 100-B (11) ◽  
pp. 1499-1505 ◽  
Author(s):  
F. Najd Mazhar ◽  
H. Ebrahimi ◽  
D. Jafari ◽  
A. Mirzaei
Keyword(s):  
Radial Head ◽  
Study Groups ◽  
Final Visit ◽  
Dash Score ◽  
Terrible Triad ◽  
Range Of Movement ◽  
Resection Group ◽  
Female Patients ◽  
Radial Head Resection ◽  
The Mean

Aims The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. Patients and Methods The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded. Results The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex–Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively. Conclusion The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient’s radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499–505.

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

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 25-31 ◽  
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.

scholarly journals Short term outcome of radial head arthroplasty in Mason type 3 and 4 fractures

2021 ◽  
Vol 7 (4) ◽  
pp. 830
Author(s):  
Mudasir Rashid Ganai ◽  
Shahid Shabir Khan ◽  
Inayat Rahim ◽  
Saheel Maajid ◽  
Tahir Ahmed Dar
Keyword(s):  
Radial Head ◽  
Functional Performance ◽  
Radial Head Fracture ◽  
Late Complications ◽  
Term Outcome ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Suitable Treatment ◽  
Comminuted Radial Head Fracture ◽  
Type 3

<p class="abstract"><strong>Background:</strong> Radial head arthroplasty provides a suitable treatment in Mason type 3 and 4 3 fractures. Arthroplasty produces consistent results with a shorter learning curve than ORIF and prevents the late complications associated with radial head excision.</p><p class="abstract"><strong>Methods: </strong>After seeking approval from local institutional ethical committee 30 patients with Mason type 3 and 4 radial head fractures were admitted from outpatient department (OPD) of SKIMS MC and Hospital Bemina, Srinagar. The study was conducted from February 2019 to June 2020 in department of Orthopaedics SKIMS MC and Hospital Bemina, Srinagar. 30 patients with mean age of 25 years comprising of 9 females and 21 males underwent radial head arthroplasty and were followed up to a minimum of 1 year post-operatively.</p><p class="abstract"><strong>Results: </strong>Outcome was evaluated by assessing elbow functional performance using Mayo elbow performance (MEPI). No revisions were performed during the study. Two patients had implant backout and 6 patients had elbow stiffness.</p><p class="abstract"><strong>Conclusions: </strong>Radial head arthroplasty can be used successfully with most of excellent results for treatment of comminuted radial head fracture (Mason type III and IV radial head fractures). Over all radial head arthroplasty is a demanding option in type 3 and type 4 fractures which are not amenable to reconstruction.</p>

Midterm results of radiocapitellar arthroplasty of the elbow

2019 ◽  
Vol 101-B (11) ◽  
pp. 1362-1369 ◽  
Author(s):  
Giuseppe Giannicola ◽  
Piergiorgio Calella ◽  
Prospero Bigazzi ◽  
Alberto Mantovani ◽  
Paolo Spinello ◽  
...  
Keyword(s):  
Radial Head ◽  
Case Series ◽  
Dash Score ◽  
Mayo Elbow Performance Score ◽  
Elbow Function ◽  
Large Case Series ◽  
Post Traumatic ◽  
The Mean ◽  
Large Case

Aims The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. Patients and Methods A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score. Results The mean follow-up was 6.8 years (3.8 to 11.5). The mean MEPS, m-ASES, and Q-DASH scores improved significantly by 50 (p < 0.001), 55 (p < 0.001), and 54 points (p < 0.001), respectively, with no differences being detected between the implants. Preoperative pronation and supination were worse in patients in whom the UNI-E was used. Two patients with the UNI-E implant had asymptomatic evidence of gross loosening. Conclusion Radiocapitellar arthroplasty yielded a significant improvement in elbow function at a mean follow-up of 6.8 years, with a high implant survival rate when the LRE was used in patients with primary or post-traumatic OA, without radial head deformity, and when the UNI-E was used in patients in whom radial head excision was indicated. Cite this article: Bone Joint J 2019;101-B:1362–1369

scholarly journals Comparison of Radial Head Resection With Radial Head Fixation in the Terrible Triad Injury of the Elbow

2019 ◽  
Vol 6 (4) ◽  
pp. 19-24 ◽  
Author(s):  
Farid Najd Mazhar ◽  
◽  
Hooman Shariatzadeh ◽  
Hanon Sadony ◽  
Nima Bagheri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Radial Head ◽  
Study Groups ◽  
Terrible Triad ◽  
Head Fixation ◽  
Fixation Group ◽  
Radial Head Resection ◽  
The Mean ◽  
Head Component ◽  
Radial Head Fixation

Background: The optimal treatment of radial head component in the terrible triad injuries of the elbow is challenging. In this study, we compared the functional outcome and complication rates of radial head resection with radial head fixation in a terrible triad setting. Objectives: Comparison of radial head resection with radial head fixation in terrible triad. Methods: In the present retrospective study, the outcome of terrible triad injury in 41 patients, in whom the radial head component was managed with either radial head resection (n=28) or open reduction and internal fixation (n=13), was compared. The subjective assessments of the outcome included visual analog scale (VAS) for pain, ‎the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and ‎hand (DASH) score. The objective assessment of outcome included the evaluation of elbow range of motion (ROM) and elbow stability. Results: The mean±SD age of the patients was 39.2±10.2 years. The demographic characteristics of the patients of the two study groups were not statistically different. The mean supination/pronation arc of motion was not significantly different between the two ‏study groups (P=0.11). The mean flexion/extension arc of motion was significantly more in the fixation group (P=0.001). The mean MEPS and DASH scores were not ‏significantly different between the study groups (P=0.22 and P=0.49, respectively). The mean ‏VAS was significantly more in the fixation group (P=0.04). All the elbows were stable at the last follow-up. The postoperative complications (arthrosis and heterotopic ossification) were considerably more in the resection group. Conclusion: Although comparable at function, the present study favors the radial head fixation whenever possible to avoid the postoperative complications of radial head reaction.

Acute Radial Head Resection for Fracture: are We Likely to Miss an Essex-Lopresti Injury?

2021 ◽  
Vol 23 (4) ◽  
pp. 263-270
Author(s):  
Dafang Zhang ◽  
Kyra A. Benavent ◽  
George S. M. Dyer ◽  
Brandon E. Earp ◽  
Philip Blazar
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Radial Head Fractures ◽  
Pain Scores ◽  
Radial Head Resection ◽  
Forearm Instability ◽  
Level I ◽  
Pull Tests ◽  
Essex Lopresti

Background. Given the current available evidence, surgical treatment of radial head fracture with acute resection is controversial. The aim of this study was to determine whether acute resection of the radial head for a radial head fracture leads to longitudinal forearm instability due to a missed Essex-Lopresti injury. Material and methods. A retrospective review was conducted of radial head resections performed for acute radial head fractures at two Level I trauma centers from 2000 to 2018. A total of 11 patients met inclusion criteria. Our primary outcome was a missed Essex-Lopresti injury at time of final clinical follow-up. Long-term telephone follow-up was attempted for QuickDASH, pain scores, and satisfaction scores. Results. Of the 11 radial head fractures in this study, intraoperative radial pull tests were performed and normal in 6 patients. No patient was found to have a missed Essex-Lopresti injury at a mean of 36.2 months’ clinical follow-up after radial head resection. At a mean telephone follow-up of 12.6 years in available patients, mean QuickDASH was 3.4, mean satisfaction was 9.75 out of 10, and no further complication or reoperation was reported. Conclusion. Our findings challenge the dogma that the radial head cannot be safely excised in the setting of acute fracture, even with elbow instability and/or wrist pain, particularly when intraoperative longitudinal stability is assessed by a stress maneuver.

scholarly journals Evaluation of two different types of radial head prosthesis in practical use. Using either Evolve® or MoPyC® radial head prosthesis in the treatment of comminuted radial head fractures

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Tim Friedrich Raven ◽  
Lukas Banken ◽  
Gerhard Schmidmaier ◽  
Stefan Studier-Fischer ◽  
Bahram Biglari ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Radial Head Prosthesis ◽  
Radial Head Fractures ◽  
Functional Scores ◽  
System Assessment ◽  
And Function ◽  
Comminuted Radial Head Fracture

The aim of this retrospective study was to undertake a comparative evaluation of the Evolve® modular metallic radial head implant prosthesis and the MoPyC® pyrocarbon prosthesis in acute care. Seventyfive patients having a comminuted radial head fracture with an Evolve® prosthesis (=G1) and 11 with a MoPyC® prosthesis (=G2) were available for a follow-up. Postoperative patient outcomes were evaluated according to a standardized follow-up protocol which included the Morrey rating system. Assessment criteria were range of motion (ROM), functional scores, and rate of complications. G1 showed a mean Morrey score of 86 points. Four direct prosthesis complications were observed in this group (n=75). The average achieved Morrey score in G2 was 84 points. In this group (n=11), 2 direct prosthesis complications were diagnosed. The average range of motion did not differ greatly between both groups. Radial head replacement with either prosthesis yielded sufficient to satisfactory results in a mid-term perspective regarding the range of motion and function of the elbow joint when performed in carefully selected patients. The Evolve® Prothesis appears to show a slightly lower rate of complication by way of a similar functional outcome.

Long-term Outcome of Open Synovectomy with Radial Head Resection for Rheumatoid Elbow

2018 ◽  
Vol 23 (02) ◽  
pp. 192-197
Author(s):  
Masanori Nakayama ◽  
Yu Sakuma ◽  
Hitoshi Imamura ◽  
Koichiro Yano ◽  
Katsunori Ikari
Keyword(s):  
Radial Head ◽  
Valgus Deformity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Open Synovectomy ◽  
Radial Head Resection ◽  
Flexion Extension ◽  
The Mean ◽  
Carrying Angle

Background: We reviewed our surgical results of open synovectomy with radial head resection for rheumatoid elbow. Methods: We reviewed the 20 patients (22 elbows) underwent open synovectomy for rheumatoid elbows retrospectively. The minimum follow-up period is over 10 years, and the average was 13 years 4 months. Surgical outcomes were evaluated using the VAS pain scale, range of motion, and radiologic outcomes including Larsen’s grade and carrying angle. Results: The mean VAS score was 39 (range, 10–90) at last follow-up. The only one patient underwent revision surgery. The mean flexion-extension range of elbow was -28°–112° and arc of motion was 82° before surgery. The mean flexion-extension range of elbow was -23°–114°, and arc of motion was 90° at last follow-up. Radiologic findings of nine elbows in 21 elbows worsened at last follow-up according to the Larsen–s grade. Carrying angle increased by mean 4.2°, and it increased by 10° or more in four elbows. Conclusions: Our results show that open synovectomy with radial head resection resulted in functional motion maintenance and pain control for a long time, but often resulted in an elbow valgus deformity. Our findings suggest open synovectomy can be considered as palliative treatment for painful rheumatoid elbow.

scholarly journals Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Ogawa ◽  
H Sekiguchi ◽  
K Jujo ◽  
E Kawada-Watanabe ◽  
H Arashi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Primary Outcome ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Hypertensive Patients ◽  
Mean Values ◽  
Comprehensive Management ◽  
The Mean ◽  
Artery Disease

Abstract Background There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial. Methods HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of &lt;130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up. Results During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP. Conclusions The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD. Figure 1 Funding Acknowledgement Type of funding source: None

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