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

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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Functional outcome of radial head replacement in isolated radial head fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170903 ◽

2017 ◽

Vol 3 (3) ◽

pp. 362

Author(s):

Rahul Kadam ◽

Chinmoy Sharma ◽

Santosh Pandhare ◽

Abhay Chhallani ◽

Abhishek Gupta ◽

...

Keyword(s):

Functional Outcome ◽

Radial Head ◽

Elbow Joint ◽

Early Mobilization ◽

Soft Tissue Reconstruction ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

Replacement Arthroplasty ◽

Mayo Elbow Score

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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Surgical treatment of the radial head is crucial for the outcome in terrible triad injuries of the elbow

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0762.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1620-1628

Author(s):

Alexander Klug ◽

Angela Nagy ◽

Yves Gramlich ◽

Reinhard Hoffmann

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Independent Effect ◽

Type I ◽

Dash Score ◽

Type Ii ◽

Terrible Triad ◽

Radial Head Fractures ◽

Type Iii

Aims To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Methods Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible. Results At follow-up the mean MEPS was 87.1 (20 to 100); mean OES, 36.9 (6 to 48); and mean DASH score, 18.6 (0 to 90). Mean movement was 118° (30° to 150°) for extension to flexion and 162° (90° to 180°) for pronation to supination. The overall reoperation rate was 24%, with nine ORIF, ten RHA, and two patients without treatment to the radial head needing surgical revision. When treated with RHA, Mason type III fractures exhibited significantly inferior outcomes. Suboptimal results were also identified in patients with degenerative or heterotopic changes on their latest radiograph. In contrast, more favourable outcomes were detected in patients with successful radial head reconstruction after Mason type III fractures. Conclusion Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most TTIs. Although some bias in treatment allocation, with more severe injuries assigned to RHA, cannot be completely omitted, treatment of radial head fractures may have an independent effect on outcome, as patients subjected to RHA showed significantly inferior results compared to those subjected to reconstruction, in terms of elbow function, incidence of arthrosis, and postoperative complications. As RHA showed no apparent advantage in Mason type III injuries between the two treatment groups, we recommend reconstruction, providing stable fixation can be achieved. Cite this article: Bone Joint J 2020;102-B(12):1620–1628.

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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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Osteochondral Autograft Transportation vs Arthroscopic Fragment Resectionfor Large Capitellar Osteochondritis Dissecans in Adolescent Athletes - A Minimum of 5-year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00368 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0036

Author(s):

Yusuke Ueda ◽

Hiroyuki Sugaya ◽

Norimasa Takahashi ◽

Keisuke Matsuki ◽

Hiroshige Hamada ◽

...

Keyword(s):

Radial Head ◽

Functional Outcomes ◽

Dash Score ◽

Functional Scores ◽

The Mean ◽

Group 2 ◽

Grade 3 ◽

Osteochondral Grafting ◽

Group 1

Objectives: Small capitellar osteochondritis dissecans (OCD) lesions have shown excellent functional and radiographic outcomes after arthroscopic (AS) fragment resection in previous studies. However, surgical options for unstable large capitellar OCD lesions in skeletally immature athletes remains controversial. Before 2007, we exclusively performed AS fragment resection for all inviable lesions regardless of lesion size. However, we initiated to perform osteochondral grafting for selected larger lesions in the year of 2007. The purpose of this study is to investigate functional outcomes and radiographic changes after osteochondral grafting and AS fragment resection for unstable large capitellar OCD lesions(>1/2 radial head diameter) in skeletally immature athletes with a minimum of 5-years follow-up. Methods: Group 1 consisted of 19 elbows in 19 patients (19 males; 16 baseball, 2 badminton and 1 gymnastics) that underwent osteochondral grafting for capitellar OCD (mean age, 14; range, 13-15), and the mean follow-up was 8 years (range; 5-11). Group 2 consisted of 21 elbows in 19 patients (17 males and 2 females; 16 baseball, 2 gymnastics and1 handball) that underwent AS fragment resection (mean age, 14. range, 13-15), and the mean follow-up was 8 years (range, 5-10). Preoperatively, the mean transverse diameter of lesions was 13 mm (range, 11-14) in Group 1 and 13 mm (range, 10-16) in Group 2. Superior migration of the radial head (>2-mm side-to-side difference) was seen in four elbows in Group 1 and one elbow in Group 2. Radial head enlargement with more than 20% of the contralateral side was seen in seven elbows in Group 1 and one elbow in Group 2. Functional scores (JOA score, DASH score and patient satisfaction), range of motion (ROM), and radiographic findings including Kellgren-Lawrence osteoarthritis (OA) grade were evaluated and compared between the groups. Results: All patients returned to sports activity. Functional scores at the final follow-up were not different between Group 1 and 2: JOA score, 90 (range, 68-100) vs 91 (range, 82-100); DASH score, 1 (range, 0-7) vs 3 (range, 0-14); Patient satisfaction, 84 (range, 50-100) vs 81 (range, 50-100). Flexion ROM at the final follow-up did not show significant improvement in both groups compared to preoperative values, though there was a significant difference at the final follow-up between the groups: Group 1, 133º (range, 115-150º); Group 2, 133º (range, 120-145º). Extension ROM showed significant improvement in both groups (P<.001 for both): Group 1, -18º (range, -35-0º) to -8º (range, -22-10º); Group 2, -17º (range, -50-0º) to 0º (range, -10-20º). Group 2 had significantly better extension than Group 1 at the final follow-up (P =.003). OA change progressed in 12 elbows (63%) in Group 1 and in 9 elbows (47%) in Group 2. There were four grade 3 OA elbows in Group 1, which preoperatively had superior migration and enlargement of the radial head. No elbows showed severe OA change in Group 2. Conclusion: Functional outcomes and radiological findings after both osteochondral grafting and AS fragment resection for unstable large capitellar OCD lesions in adolescent athletes were satisfactory with a mean follow-up of 8 years. However, grade 3 OA were seen after osteochondral grafting in four elbows with preoperativesuperior migration of the radial head. Osteochondral grafting should be performed before radiographical changes become severe.

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169 Clinical Outcomes of Radial Head Arthroplasty as Primary Treatment for Post-traumatic Mason Type 3 and 4 Fractures: A Long-term Follow-up

British Journal of Surgery ◽

10.1093/bjs/znab258.054 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Aslam ◽

K Pearson ◽

M Waseem

Keyword(s):

Clinical Outcomes ◽

Radial Head ◽

Primary Treatment ◽

Functional Restoration ◽

Dash Score ◽

Range Of Movement ◽

Radial Head Fractures ◽

Radial Head Arthroplasty

Abstract Aim Radial head arthroplasty (RHA) is the favoured treatment for complex radial head fractures, enabling functional restoration of elbow kinematics. However, study of long-term outcomes associated with RHA is largely neglected. This study aimed to fill the gap in the literature by firstly, assessing functional outcomes, and secondly, determining complications and rates of revision and/or removal of prosthesis associated with RHA, at our district general hospital. Method We retrospectively reviewed a consecutive single-surgeon series of patients receiving RHA as primary treatment for radial head fractures graded either 3 or 4 according to the Mason-Johnston classification between 2004 and 2009. Function at final follow-up was assessed using Quick Disabilities of the Arm, Shoulder and Hand (q-DASH) score and Mayo Elbow Performance Score (MEPS). Results 16 patients identified; 12 available for final follow-up. Mean follow-up time of 12.60 years (range: 10.67-16.08). Mean q-DASH score of 8.2 (range: 0-34.1). Mean MEPS of 85.83 (range: 50-100) with 11 (91.67%) reporting excellent/good results. All complications occurred within the first year post-operatively. Stiffness was the most common (50%) complication, but additional procedures improved objective range of movement in affected patients. Only one patient required implant revision throughout follow-up, which was due to prosthesis subluxation in the first month. Conclusions This study is amongst the first to examine clinical outcomes associated with RHA with an average follow-up >12 years. Our results emphasise good functional restoration and low implant failure rate. Regular follow-up particularly in the early post-operative period is essential in detecting and resolving complications.

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Midterm results of radiocapitellar arthroplasty of the elbow

The Bone & Joint Journal ◽

10.1302/0301-620x.101b11.bjj-2019-0155.r2 ◽

2019 ◽

Vol 101-B (11) ◽

pp. 1362-1369 ◽

Cited By ~ 2

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

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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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Ligament Reconstruction of Traumatic Pure Dislocation of Carpometacarpal Joint of the Thumb: A Series of Acute and Chronic Cases

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1718789 ◽

2020 ◽

Vol 12 (S 01) ◽

pp. S16-S20

Author(s):

Farid Najd Mazhar ◽

Davod Jafari ◽

Seyed Sajjad Jafari ◽

Alireza Mirzaei

Keyword(s):

Grip Strength ◽

Outcome Measures ◽

Ligament Reconstruction ◽

Reconstruction Technique ◽

Reconstruction Method ◽

Dash Score ◽

The Mean ◽

Quick Dash ◽

Cmc Joint

Abstract Background Traumatic instability of carpometacarpal (CMC) joint of the thumb without a fracture (pure dislocation of CMC joint) is an uncommon injury, and a universally accepted protocol has not yet been developed for its management. Here, we aim to evaluate the outcome of this injury managed with ligament reconstruction technique, in a series of acute and chronic injuries. Patients and Methods Total nine patients (six acute and three chronic) with pure dislocation of CMC joint who underwent ligament reconstruction surgery were included in this retrospective study. Outcome measures included disabilities of the arm, shoulder, and hand (quick-DASH) questionnaire; visual analog scale (VAS) scoring system; patient-rated wrist/hand evaluation (PRWHE) system; pinch and grip strength; and Kapandji thumb opposition scores. Results The patients’ mean age was 32.55 ± 11.4 years. Their mean follow-up period was 27 ± 12.8 months. The mean postoperative pinch and grip strength was equivalent to 91.5% and 108% of the contralateral hand, respectively. The mean Quick-DASH score was 14.7 ± 19.4. The mean PRWHE score was 18.7 ± 22.4. The mean VAS was 1.1 ± 1.5. The mean Kapandji score was 8.3 ± 1.4. The pinch and grip strength were considerably superior in acute injuries. Degenerative changes were seen in all joints at the latest follow-up. None of our patients needed a revision surgery. Conclusion Ligament reconstruction method could result in favorable outcome in the management of pure dislocation of CMC joint. However, delayed surgery of this injury might adversely affect the outcome measures.

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Dual Plate Fixation of Mason Type III and IV Radial Neck Fractures: a Mid-term Follow-up of 9 Cases

10.21203/rs.3.rs-176866/v1 ◽

2021 ◽

Author(s):

Kai Ye ◽

Hui Qin ◽

Zhiquan An

Keyword(s):

Radial Head ◽

Plate Fixation ◽

Elbow Flexion ◽

Dash Score ◽

Type Iii ◽

Radial Neck ◽

Radial Neck Fractures ◽

Dual Plate ◽

The Mean

Abstract Background: Radial head and neck fractures commonly occur in elbow injuries. The purpose of the present study was to evaluate the effectiveness of the dual plate fixation technique for fractures of the radial neck.Methods: This prospective study included 9 patients who were referred to our department by trauma surgeons between July 2014 and March 2018. 8 patients had a Mason type III fracture, and 1 patient had a Mason type IV fracture. The functional outcomes of dual plate fixation were evaluated via the range of motion (ROM) of the elbow joint, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Elbow Performance Index (MEPI), and the Broberg and Morrey Index. Radiographic images were also reviewed during follow-up.Results: After a mean follow-up period of 50 months (24–69), the mean elbow flexion was 134°, extension was 5°, pronation was 76°, and the mean supination was 78°. The mean DASH score was 6.3. The mean MEPI was 97, and the mean Broberg and Morrey Index was 97. At the time of the last follow-up, the average humeroradial joint space was 2.5 mm, and the average inclination of the radial head relative to the neck was 2.2°. There were no incidences of wound infection, delayed union, nonunion of the fracture, or secondary displacement.Conclusions: Mason type III–IV radial neck fractures can be fixed using the dual plate technique with sufficient midterm results for both fractures that involve the radial head and those that do not. Trial registration: 2020-KY-096(K)

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