Is radial head resection a menace for the clinical outcomes of the elbow for comminuted radial head fractures?

Authors

  • B. Mohan Choudhary Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  • S. Pradeesh Kiswanth Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  • R. Dorai Kumar Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20185088

Keywords:

Comminuted radial head fracture, Mason type III fractures, Radial head resection, Indian population

Abstract

Background: Radial head fractures are about 20% of all the elbow fractures. Comminuted radial head fractures can cause great impairment on upper extremity functional status. In older times, radial head resection was the treatment of choice for comminuted radial head fractures. Recently, radial head implant arthroplasty has become popular for fractures that could not be fixed. In this study, we assess the clinical outcomes in patients who underwent Radial head resection in Indian population of the productive age group.

Methods: Prospective study of 15 patients of age more than 18 and less than 50 years of age, who have underwent radial head resection for Mason type III radial head fractures. Outcomes were evaluated according to the Mayo Elbow Performance Score at 3 months, 6 months and at 1 year follow up.

Results: We observed that 80% of our patients were pain free at the end of 1 year and 20% had minimal to moderate pain. About 80% of our patients regained their “functional range” of movements. 12 of our patients had a stable elbow joint and only 3 patients complained of minimal to moderate instability after the procedure. 87% of our patients had a good to excellent functional outcome at the end. The mean Mayo elbow performance score was 92.3 which is graded as excellent and did not have any significant complications to hinder the clinical outcome.

Conclusions: Radial head resection yields a good to excellent clinical results in young Indian population with isolated comminuted radial head fractures.

References

Desault PJ. A treatise on fractures, luxations and affection of the bones. Bichat X, editor. Philadelphia: Kimber & Conrad; 1811.3.

Helferich H. Fractures and dislocations. J. Hutchinson J, editor. New Sidenham Society; 1899: 96-97.

Conn J, Wade PA. Injuries of the elbow (a ten year review). J Trauma. 1961;1:248-61.

Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J. 1962;31:51-6.

Lindenhovius AL, Buijze GA, Kloen P, Ring DC. Correspondence between perceived disability and objective physical impairment after elbow trauma. J Bone Joint Surg Am. 2008;90(10):2090-7.

Thomas TT. Fractures of the head and the radius. Univ Pa Med Bull. 1905;18:184-97.

Hammond R. Fracture of the head and neck of the radius. Ann Surg. 1910;53:207.

Rabourdin AN. Fractures of the head of the radius. Paris: Steinheill; 1910.

Hizrot J. The treatment of simple fractures:a study of some end results. Ann Surg. 1912;55:338.

Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 2008;39(2):173-185.

Pike JM, Athwal GS, Faber KJ, King GJ. Radial head fractures—an update. J Hand Surg Am. 2009;34(3):557-65.

Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head:comparison of resection and internal fixation. J Bone Joint Surg Am. 2005;87(1):76-84.

Faldini C, Pagkrati S, Grandi G, Digennaro V, Lauretani G, Faldini O, Giannini S. What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-year follow-up. J Orthop Traumatol. 2006;7:126-30.

Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am. 1986;68:675-9.

Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am. 1987;69:385-92.

Miralles FA, Sebastia´c E, Cebria´cn R, Lizaur A. Resultados funcionales de las resecciones de la cabeza radial tras su fractura. Rev Ortop Traumatol. 2004;48:12-6.

Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68:669-74.

Fuchs S, Chylarecki C. Do functional deficits result from radial head resection? J Shoulder Elbow Surg. 1999;8:247-51.

Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004;86:1925-30.

Herbertsson P, Josefsson PO, Hasserius R, Karlsson C, Besjakov J, Karlsson M. Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study. J Bone Joint Surg Am. 2004;86:569-74.

Hotchkiss RN, Weiland AJ. Valgus stability of the elbow. J Orthop Res. 1987;5:372-7.

King GJ, Evans DC, Kellam JF. Open reduction and internal fixation of radial head fractures. J Orthop Trauma. 1991;5:21-8.

Shore BJ, Mozzon JB, MacDermid JC, Faber KJ, King GJ. Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am. 2008;90:271-80.

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

Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63(6):872–7.

Antuña SA, Sánchez-Márquez JM, Barco R. Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old. J Bone Joint Surg [Am]. 2010;92:558.

Iftimie PP, Calmet Garcia J, de Loyola Garcia Forcada I, Gonzalez Pedrouzo JE, Giné Gomà J. Resection arthroplasty for radial head fractures: long-term follow-up. J Shoulder Elbow Surg. 2011;20:45–50.

Yalcinkaya M, Bagatur AE, Erdogan S, Zorer G. Resection arthroplasty for mason type iii radial head fractures yield good clinical but poor radiological results in the long-term. J Orthop. 2013;36(11):1358-64.

King GJW, Faber KJ. Post Traumatic Elbow Stiffness. Orthop Clin N Am. 2000;31:129-14.

Paschos NK, Mitsionis GI, Vasiliadis HS, Georgoulis AD. Comparison of Early Mobilization Proto-cols in Radial Head Fractures. J Orthop Trauma. 2013;27:134-9.

Harding P, Rasekaba T, Smirneos L, Holland AE. Early Mobilisation for Elbow Fractures in Adults. In: The Cochrane Collaboration and P. Harding, Eds., Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons, Ltd; 2011.

Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80:231-3.

Mikic ZD, Vukadinovic SM. Late results in fractures of the radial head treated by excision. Clin Orthop. 1983;181:220-8.

King BB. Resection of the radial head and neck:an end-result study of thirteen cases. J Bone Joint Surg. 1939;21:839-57.

Wallace AL, Walsh WR, van Rooijen M, Hughes JS, Sonnabend DH. The interosseus membrane in radio-ulnar dissociation. J Bone Joint Surg [Br]. 1997;79:422-7.

Postacchini F, Morace GB. Radial head fracture treated by resection: long-term results. Ital J Orthop Traumatol. 1992;18:323-30.

Rokjaer M, Knudsen H. Fractures of the head and neck of the radius treated by excision. Acta Chir Scand. 1972;138:793-7.

Van Riet RP, Sanchez Sotelo J, Morrey BF Failure of metal radial head replacement. Joint Surg Br. 2010;92(5):661-7.

Delclaux S, Lebon J, Faraud A, Toulemonde J, Bonnevialle N, Coulet B, et al. Complications of radial head prostheses. Int Orthop. 2015;39(5):907–13.

Bimmel R, van Riet RP, Sys J. Heterotopic ossification causing proximal radioulnar synostosis after insertion of a radial head prosthesis. J Hand Surg [Br]. 2006;31:383–4.

Downloads

Published

2018-12-25

Issue

Section

Original Research Articles