Aseptic Destruction of the Elbow Joint after Radial Head Replacement. Case Study

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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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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KPS Bipolar Radial Head Arthroplasty – Polyethylene Head Replacement with a Metal-covered Head. Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.2133 ◽

2018 ◽

Vol 20 (3) ◽

pp. 229-237

Author(s):

Kamila Malesa ◽

Mariusz Urban ◽

Dariusz Michalik ◽

Stanisław Pomianowski

Keyword(s):

Clinical Outcome ◽

Internal Fixation ◽

Surgical Procedures ◽

Radial Head ◽

Open Reduction ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

Therapeutic Results

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been obtained, this procedure, like any other surgical procedures, may be associated with severe complications, including contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has always been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

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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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Metallic Press-fit Radial Head Replacement for Radial Head Fractures

Orthopedics ◽

10.3928/01477447-20190604-07 ◽

2019 ◽

Vol 42 (6) ◽

pp. e545-e551

Author(s):

Ki Jin Jung ◽

Jae-Hwi Nho ◽

Soon-Do Wang ◽

Yong Cheol Hong ◽

Byung Sung Kim

Keyword(s):

Radial Head ◽

Radial Head Fractures ◽

Radial Head Replacement ◽

Press Fit

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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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Comparative Biomechanical Analysis of Stress–Strain State of the Elbow Joint After Displaced Radial Head Fractures

Journal of Medical and Biological Engineering ◽

10.1007/s40846-017-0334-1 ◽

2017 ◽

Vol 38 (4) ◽

pp. 618-624

Author(s):

Sergey Strafun ◽

Ievgen Levadnyi ◽

Vasily Makarov ◽

Jan Awrejcewicz

Keyword(s):

Radial Head ◽

Elbow Joint ◽

Strain State ◽

Biomechanical Analysis ◽

Stress Strain ◽

Radial Head Fractures ◽

Stress Strain State

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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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