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

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.

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 Radial head fractures with interposed capitellar cartilage fragment–hindrance to bone healing–a case series

2021 ◽  
Author(s):  
Andreas Harbrecht ◽  
Michael Hackl ◽  
Tim Leschinger ◽  
Kilian Wegmann ◽  
Dominik Seybold ◽  
...  
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Case Series ◽  
Fracture Site ◽  
Individual Treatment ◽  
Radiological Imaging ◽  
Radial Head Fractures ◽  
Concomitant Injury ◽  
Primary Osteosynthesis

Abstract Introduction Radial head fractures account for the majority of bony elbow injuries. The individual treatment options have been described in detail. In some cases, however, an unusual concomitant injury occurs, which can significantly impede primary osteosynthesis and healing. This concomitant injury can be an interposing cartilaginous capitellar fragment. Methods This retrospective study describes four cases of trapped cartilage fragments of the capitellum that compromised primary osteosynthesis or primary conservative healing of a radial head fracture. Radiological imaging, function and pain level are presented pre- and postoperatively (mean follow-up 9.25 months). Results None of the four cases showed preoperative evidence of an incarcerated cartilage fragment of the capitellum. They all showed limited elbow range of motion. CT examinations were performed in all cases. In each case, the cartilage fragment was first sighted upon surgery, subsequently removed and the fractures treated with ORIF. Mean follow-up was of 9.25 months. All fractures healed, with excellent function and low pain scores. Conclusions This study presents rare cases of a trapped humeral cartilage fragment in radial head fractures. Radiological imaging including CT scans cannot reliably detect this concomitant injury. Therefore, this problem becomes apparent and treatable only during surgery. A high degree of suspicion is necessary especially in patients with minimally displaced fractures associated with limited elbow motion and a gap at the fracture site as treating these injuries conservatively may lead to poor outcome.

Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: a retrospective study of 40 patients

2020 ◽  
Author(s):  
Liang Guo ◽  
睿夫 li ◽  
Xuhui Yang ◽  
Chao Yu ◽  
Fei Gui
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fracture ◽  
Treatment Plan ◽  
Young Patients ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Metallic Implants ◽  
Radial Head Resection

Abstract Background The treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation are hard to achieve. Common techniques include radial head resection and arthroplasty. Both methods have characteristic complications. The present study aims to demonstrate the feasibility of treating unreducible radial head fractures with absorbable polylactide pins. Methods A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic implants. Patients receiving both modalities were followed-up for a mean of 15 months (standard deviation [SD]: 2.6). Radiographic analysis was conducted 2, 30, 60 and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test. Result All fractures healed successfully. The data shows no statistical difference between the polylactide and metallic implant groups. Complications were infrequent and did not cause disability. All patients were satisfied with the surgical outcomes. Conclusion Polylactide pins can feasibly treat severely comminuted radial head fractures which are normally considered unreducible. The outcomes were similar to those of metallic implants. This technique provides an optional treatment plan in addition to resection and arthroplasty, especially for young patients that refuse that form of treatment.

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.

INTERNAL FIXATION OF RADIAL HEAD FRACTURES WITH AN INTRAMEDULLARY NAIL

2013 ◽  
Vol 25 (01) ◽  
pp. 1350007
Author(s):  
Matija Krkovic ◽  
Miha Brojan ◽  
David Bombac ◽  
Dejan Hermann
Keyword(s):  
Intramedullary Nail ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Vascular Supply ◽  
General Idea ◽  
Stable Fixation ◽  
Radial Head Fractures ◽  
Design And Manufacturing ◽  
Comminuted Fractures ◽  
Thin Walled

Comminuted fractures of the radial head still present significant technical and surgical challenges. In this article, we describe a novel fixation of comminuted radial head fractures with the help of an intramedullary nail. Experiments with solid, conventionally machined intramedullary nails showed some major drawbacks in the fixation of radial head fractures. Several design and manufacturing procedures were proposed. The general idea behind the new design was the concept of a nail which would eliminate the need for prefabricated bores. Experiments with a selective laser sintered thin-walled nail, designed with the help of CT images, fulfilled expectations. This thin-walled proximal radius nail thus offers a stable fixation of the radial head fracture fragments, with the ability to preserve the existing vascular supply to the radial head fragments, and therefore not just use the reconstructed radial head as a bioprosthesis.

scholarly journals A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

2020 ◽  
Author(s):  
Xu Gao ◽  
Fei Li ◽  
Yong-Qiang Sui ◽  
Rui Huang ◽  
Hai-yu Fan ◽  
...  
Keyword(s):  
Radial Head ◽  
Plate Fixation ◽  
Visual Analog Scale Score ◽  
Reconstruction Technique ◽  
Hybrid Technique ◽  
Self Assessment ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Intramedullary Pinning

Abstract BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

Radius and Ulna Trauma

2019 ◽  
pp. 65-67
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Radial Head ◽  
Distal Radioulnar Joint ◽  
Monteggia Fracture ◽  
Radial Head Fractures ◽  
Type Iv ◽  
Ulnar Fracture ◽  
Fracture Dislocations ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Essex Lopresti

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

Elbow Trauma

2019 ◽  
pp. 62-64
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Operative Treatment ◽  
Radial Head ◽  
Preoperative Assessment ◽  
The Body ◽  
Synovial Joint ◽  
Radial Head Fractures ◽  
Elbow Trauma ◽  
Acute Injuries ◽  
Large Joint

Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the second most commonly dislocated large joint of the body. Radiographs are the mainstay in the evaluation of acute injuries and treatment follow-up. CT examination is helpful in preoperative assessment of complex fractures/injuries. All elbow dislocations are initially close reduced and splinted. Further conservative versus operative treatment depends on complexity of injury.

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