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

<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>

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

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.

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

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.

Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery.RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms.CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.