Effects of an on-Table Reconstruction Technique Combined with Miniplate Internal Fixation and Prosthesis for the Treatment of Isolated Mason III Radial Head Fractures

Background In this retrospective study we analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with an on-table reconstruction technique combined with miniplate internal fixation or prosthesis. Methods This study included 42 patients affected by isolated radial head Mason III fractures and treated between Jan 2012 and Jan 2019. Twenty-four patients (average age 45.6 years) were treated with an on-table reconstruction technique combined with miniplate internal fixation. The remaining 18 (average age 44.5 years) were treated with prosthesis. From a clinical point of view, we evaluated the patients according to the Broberg–Morrey scoring system and the (disabilities of the arm, shoulder, and hand) DASH questionnaire for parameters. Results We found similar results in both the groups according to Broberg–Morrey score system and the DASH questionnaire at the last follow-up. The scores of the prosthesis group were better than those of the internal fixation group at the 1st, 3rd, and 6th month follow-up post-operation. Conclusion Both the on-table reconstruction technique combined with the miniplate internal fixation and prosthesis can be effective in treating patients with isolated Mason III radial head fractures. There was no difference in elbow function between the two groups at the last follow-up; however, a prosthesis favors early functional recovery of the elbow.

Comparative Study between Surgical Excision of Radial Head Fracture versus Arthroplasty, a Systematic Review of Literature

Background Radial head fracture is the most frequently diagnosed fracture of the elbow in adults. The radial head is a secondary valgus stabilizer of the joint and it is involved in transmission of axial force load through the elbow during flexion. It is also a varus and external rotatory constraint. Aim of the Work to compare the functional outcome between excision of head radius and Arthroplasty in surgical management of radial head fractures (Mason types III and IV) and to assess the complications of both techniques. Patients and methods This systemic review included subjects suffered comminuted radial head fracture Mason type III or type IV treated by radial head excision or arthroplastyin the last 14 years from 2004 till 2018. Results: The database search identified 152 potentially relevant articles. Abstracts have been analyzed following inclusion and exclusion criteria and a total of 17 papers were selected for the present review. Most of retrospective studies on metal radial head prosthesis have been published in the last ten years in comparison to a lack of studies for radial head excision in the last two decades. Moreover, few articles on comparison of the two surgical techniques have been found. Because of heterogeneity in level of evidence, surgical technique, type of implants, and rehabilitation protocol, we did not perform statistical data analysis. Conclusion No clinical differences between radial head excision and arthroplasty as both methods are considerable regarding complication on long & mid-term follow up and functional outcome assessed by DASH, VAS, MEPS & ROM.

Extracorporeal Reconstruction of the Radial Head

Radial head fractures are common in adults. The radial head acts as an important stabilizer of the radius, especially during the forearm pronation and supination. Surgical treatment of Mason type III fracture of the radial head includes radial head excision, radial head replacement and open reduction and internal fixation. For patients treated with radial head excision, the radius might migrate proximally, causing complications such as chronic pain at the wrist, forearm, and elbow. On the other hand, radial head arthroplasty is associated with a high revision and removal rate. Hence, openreduction and internal fixation are preferred when feasible. This is technically demanding due to the severe displacement of the radial head fragments and limited surgical space. Mr K, a 30-year-old manual worker sustained a closed right radial head fracture Mason type III after an alleged fall. The radial head was displaced anteriorly. Intra-operatively, the radial headpieces were retrieved and were reconstructed extracorporeal and fixed with a miniplate. The patient subsequently recovered with good function. The new technique of extracorporeal reconstruction of the radial head offers a viable option to the surgeon with similar, or even better, outcomes in terms of elbow function.

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

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.

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

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.

Evaluation of results of fracture head and neck of radius managed by varius methods

Radial head fractures are the most frequent fracture type reported around the elbow. Fractures have been documented to occur in isolation or with other associated osseous and soft tissue injuries. However, despite intensive research into these injuries, controversies still exist regarding the role of further imaging modalities, the use of non-operative management, as well as the indication and technique for operative intervention. To analyses the clinical and functional outcome of patients with head and neck fracture of radius managed by conservative method, open reduction and internal fixation, radial head prosthesis and radial head excision. This study “evaluation of results of fracture head and neck of radius managed by various methods” was carried out in M.K.C.G Medical College, Berhampur from September 2017 to October 2019. Eighty patients of radial head and neck fractures were treated and hereby included in our study. We collected records of the patients by asking the patients history and examining the patients. Essential investigations of all the patients were done. The primary outcome measures were the surgeon reported Mayo Elbow Score (MES) and the patient reported Short Musculoskeletal Function Assessment (SMFA). Current evidence supports open reduction and internal fixation of simple Mason type II fractures. For Mason type III fractures, controversy still exists regarding the optimal treatment. Studies currently show good to excellent results with radial head replacement in the majority of patients with Mason type III fractures with three or more fracture fragments.

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

Background Management 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, 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. A hybrid technique combining with intramedullary pining was performed in our study 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. Methods The clinical, functional and radiographic outcomes of the groups were compared 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 (ROM) in the elbow, Visual Analog Scale (VAS) score, Elbow Self-Assessment score (ESAS), Mayo Elbow Performance score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score. Results Thirteen patients with unstable fractures were participated with an average follow-up of (38.6 ± 4.5) months for the experimental group and (32.0 ± 6.3) months for the control group, respectively. The functional outcomes in the experimental group, including MEPS and DASH, were significantly superior to the control group. However, no significant difference was observed in the elbow ROM and VAS score between two groups. In the last follow-up, one patient with post-traumatic arthritis rated as grades 1 and two with heterotopic ossifications were observed in the experimental group. In the control group, degenerative changes were observed in three cases (grade 1 in two cases and grade 2 in one case) and heterotopic ossifications rated as grade I were found in two patients. Conclusion Collectively, 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.