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Archives of Orthopaedic and Trauma Surgery

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01-12-2019 | Radial Head Fracture | Trauma Surgery

Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?

Authors: Jens Everding, Michael J. Raschke, Patrick Polgart, Niklas Grüneweller, Dirk Wähnert, Benedikt Schliemann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2019

Abstract

Introduction

Complex radial head fractures are difficult to treat. In cases where stable fixation cannot be achieved, radial head resection or primary arthroplasty are frequently performed. Ex situ reconstruction of comminuted fractures may also be an option. This technique has widely been neglected in the literature, and only two small case series report satisfactory results. The aim of the present case series was to determine the functional and radiological outcomes of ex situ reconstructed Mason III and Mason IV fractures. We expect that the on-table reconstruction of comminuted radial head fractures will lead to bony union with no avascular necrosis in the postoperative course, which will demonstrate that this operative procedure is a reasonable option.

Patients and methods

Two Mason type III and seven Mason type IV fractures (including four Monteggia-like lesions) were reconstructed ex situ. The mean age of the patients was 47 years (range 22–64). The clinical examination included RoM tests, elbow stability tests, and a neurological examination. The functional outcome was assessed with the MEPS and DASH score. The radiographic examination included a.p. and lateral views of the elbow to detect non-unions, inadequacy or loss of reduction, radial head necrosis, heterotopic ossifications and signs of posttraumatic arthritis.

Results

The mean follow-up time was 39 months (range 11–64). The mean MEPS was 82 points (range 15–100), and the mean DASH score was 20 points (range 0–85). All ex situ-reconstructed radial heads survived, and no signs of avascular necrosis were observed. Bony union was achieved in all but one patient who presented with an asymptomatic non-union. Signs of posttraumatic arthritis were found in all patients. With regard to the radial head, neither secondary resection nor arthroplasty had to be performed. All patients returned to their pre-injury occupations.

Conclusion

Ex situ radial head reconstruction can be a reliable option in the surgical treatment of complex radial head fractures associated with severe elbow trauma. Even in the midterm follow-up, no signs of avascular necrosis were observed. Modern implants may even extend the indications for reconstruction in such cases.

Level of evidence

Level IV—retrospective cohort study

Kovar FM et al (2013) Incidence and analysis of radial head and neck fractures. World J Orthop 4(2):80–84CrossRef

Pike JM et al (2009) Radial head fractures—an update. J Hand Surg Am 34(3):557–565CrossRef

Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132CrossRef

Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–56PubMedPubMedCentral

Al-Burdeni S et al (2015) Open reduction and internal fixation versus radial head arthroplasty in the treatment of adult closed comminuted radial head fractures (modified Mason type III and IV). Int Orthop 39(8):1659–1664CrossRef

Broberg MA, Morrey BF (1986) Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 68(5):669–674CrossRef

Burkhart KJ et al (2015) Locking plate osteosynthesis of the radial head fractures : clinical and radiological results. Unfallchirurg 118(11):949–956CrossRef

Chen X et al (2011) Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. Int Orthop 35(7):1071–1076CrossRef

Cronlein M et al (2017) Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 137(6):789–795CrossRef

10.

Gao Y et al (2013) Surgical interventions for treating radial head fractures in adults. Cochrane Database Syst Rev 5:CD008987

11.

Ikeda M et al. (2005) Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Jt Surg Am 87(1): 76–84.CrossRef

12.

Ikeda M et al (2003) Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Jt Surg Br 85(7):1040–1044CrossRef

13.

Lopiz Y et al (2016) Comminuted fractures of the radial head: resection or prosthesis? Injury 47(Suppl 3):S29–S34CrossRef

14.

Nalbantoglu U et al (2007) Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg Am 32(10):1560–1568CrossRef

15.

Pike JM et al (2014) Open reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries? Clin Orthop Relat Res 472(7):2120–2127CrossRef

16.

Van Glabbeek F et al (2005) The kinematic importance of radial neck length in radial head replacement. Med Eng Phys 27(4):336–342CrossRef

17.

van Riet RP, Sanchez-Sotelo J, Morrey BF (2010) Failure of metal radial head replacement. J Bone Jt Surg Br 92(5):661–667CrossRef

18.

Businger A, Ruedi TP, Sommer C (2010) On-table reconstruction of comminuted fractures of the radial head. Injury 41(6):583–588CrossRef

19.

Kiran Kumar GN et al (2015) On-table reconstruction and fixation of Mason type III radial head fractures. Chin J Traumatol 18(5):288–292CrossRef

20.

Hastings H, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10(3):417–437PubMed

21.

Wu PH et al (2017) Prospective study of surgical fixation of radial head fractures using cannulated headless compression screws for simple and complex radial head fractures. J Orthop Surg (Hong Kong) 25(2):2309499017716278

22.

Ruchelsman DE, Christoforou D, Jupiter JB (2013) Fractures of the radial head and neck. J Bone Jt Surg Am 95(5):469–478CrossRef

23.

Sun H, Duan J, Li F (2016) Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol 26(3):283–291CrossRef

Title: Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?
Authors: Jens Everding
Michael J. Raschke
Patrick Polgart
Niklas Grüneweller
Dirk Wähnert
Benedikt Schliemann
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Radial Head Fracture
Radial Head Fracture
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03250-3

At a glance: The STEP trials

Springer Medicine

Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?

Abstract

Introduction

Patients and methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

Level of evidence

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