DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20220608

Functional outcome of elbow after comminuted radial head fractures treated with radial head excision arthroplasty versus radial head prosthesis

Priyambada Kumar, Nitin S. Patil, Mithilesh A. Nikam

Abstract


Background: Aim of the study was to compare the functional outcome of the elbow after treating a Mason type III radial head fractures with radial head excision arthroplasty versus radial head arthroplasty with prosthesis and to study the complications which occur in both techniques.

Methods: This prospective study comprised of 30 patients, with each group comprising of 15 patients each (n=15). Randomization was done; group A comprised of patients with Mason type 3 radial head fractures treated with excision arthroplasty and group B included patients with Mason type 3 radial head fractures treated with radial head arthroplasty with prosthesis. Post operatively the operated limb was immobilized in an above-elbow plaster of Paris slab for 3 weeks in all patients.

Results: Mean disabilities of the arm, shoulder and hand (DASH) score at 6 weeks was noted to be 30.13 for patients belonging to group A and 13.06 for patients in group B. The mean DASH score at 3 months follow up was calculated as 22.53 for group A and 10.66 for group B. The mean DASH score at 6 monthly follow up was noted to be 13.86 for patients in group A and 5.2 for patients in group B.

Conclusions: As evident from the radiological findings and the clinical follow up, it is safe to say that radial head arthroplasty with prosthesis produces more convincing results in terms of stability of the elbow joint, range of motion and pain as compared to radial head excision arthroplasty for the treatment of Mason type III radial head fractures. 


Keywords


Radial head, Excision arthroplasty, Radial head prosthesis, Mason classification

Full Text:

PDF

References


Karlsson KM, Herbertsson P, Nordqvist A, Besjakov J, Josefsson OP, Hasserius R. Comminuted fractures of the radial head, Favourable out

Caputo AE, Mazzocca AD, Santoro VM. The nonarticulating portion of the radial head: Anatomic and clinical correlations for internal fixation. J Hand Surg Am 1998; 23(6): 1082-90.

Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin North Am 2008; 39(2): 141-154, v.

Yamaguchi K, Sweet FA, Bindra R, Morrey BF, Gelberman RH. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am 1997; 79(11): 1653-62.

B. F. Morrey, K. N. An, and T. J. Stormont, “Force transmission through the radial head.,” The Journal of Bone & Joint Surgery, vol. 70, no. 2, pp. 250–256, 1988. come after 15–25 years of follow up in 19 patients. Acta Orthop. 2010;81(2):224–27.

S. L. Jensen, B. S. Olsen, S. Tyrdal, J. O. Søjbjerg, and O. Sneppen, “Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture: Efficacy of prosthetic replacement and ligament repair,” Journal of Shoulder and Elbow Surgery, vol. 14, no. 1, pp. 78–84, 2005.

Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 1983; 11(5): 315-9.

Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS. Reconstructive strategies for radioulnar dissociation: A biomechanical study. J Orthop Trauma 1995; 9(6): 516-22.

Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 1991; (265): 187-95.

Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 2004; 86-A(5): 975-82.

Shepard MF, Markolf KL, Dunbar AM. Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms. J Bone Joint Surg Am 2001; 83-A(1): 92-100.

Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 2004; 86-A(8): 1730-9.

Ruchelsman DE, Christoforou D, Jupiter JB. Current Concepts Review: Fracture of the radial head and neck. J Bone Joint Surg Am 2013; 95: 469-78.

Duckworth AD, McQueen MM, Ring D. Fractures of the radial head. Bone Joint J. 2013; 95-B(2):151-9.

Charalambous CP, Stanley JK, Mills SP, Hayton MJ, Hearnden A, Trail I, et al. Comminuted radial head fractures: aspects of current management. J Shoulder Elbow Surg. 2011; 20(6):996-1007.

Ring D. Radial head fracture: open reduction-internal fixation or prosthetic replacement. J Shoulder Elbow Surg. 2011; 20(2 Suppl):S107-12.

Mason ML. Some observations on fracture of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123–32.

Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res 1987; (216): 109-19.

Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS. Reconstructive strategies for radioulnar dissociation: A biomechanical study. J Orthop Trauma 1995; 9(6): 516-22.

King GJ, Zarzour ZD, Rath DA, Dunning CE, Patterson SD, Johnson JA. Metallic radial head arthroplasty improves valgus stability of the elbow. Clin Orthop Relat Res 1999; (368): 114-25.

Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type III radial head fractures with a titanium prosthesis, ligament repair and early mobilization 2005.

King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty 2001; 16(1): 112-6.

Kaas L, Struijs PA, Ring D, van Dijk CN, Eygendaal D. Treatment of Mason type II radial head fractures without associated fractures or elbow dislocation: a systematic review. J Hand Surg Am 2012; 37(7): 1416-21.

Pomianowski S, Morrey BF, Neale PG, Park MJ, O’Driscoll SW, An KN. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am 2001; 83-A(12): 1829-34.

Moungondo F, El Kazzi W, van Riet R, Feipel V, Rooze M, Schuind F. Radiocapitellar joint contacts after bipolar radial head arthroplasty. J Shoulder Elbow Surg 2010; 19(2): 230-5

Hartzler RU, Morrey BF, Steinmann SP, Llusa-Perez M, Sanchez-Sotelo J. Radial head reconstruction in elbow fracture-dislocation: monopolar or bipolar prosthesis? Clin Orthop Relat Res 2014; 472(7): 2144-50.

Barnes LF, Lombardi J, Gardner TR, Strauch RJ, Rosenwasser MP. Comparison of Exposure in the Kaplan Versus the Kocher Approach in the Treatment of Radial Head Fractures. Hand (N Y). 2019;14(2):253-258. doi:10.1177/1558944717745662

Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11. doi:10.1186/1471-2474-4-11

Ring D, Jupiter JB. Monteggia fractures in adults. J Bone Joint Surg. 1998;80:1733-44.

Morrey BF, Askew L, Chao EY. Silastic prosthetic replacement for the radial head. J Bone Joint Surg. 1981;63:454-58.

Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted Fractures of the Radial Head:Comparison of Resection and Internal Fixation Surgical Technique. JBJS. 2006;88:11–23.https://doi.org/10.2106/00004623-200603001-00002.

Zarattini G, Galli S, Marchese M, Di Mascio L, Pazzaglia UE. The surgical treatment of isolated Mason type 2 fractures of the radial head in adults: comparison between radial head resection and open reduction and internal fixation. J Orthop Trauma. 2012;26:229–35.