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08-05-2024 | Radial Head Fracture | Original Paper

Usefulness of multiple bioabsorbable Mg screws/K‑wires for comminuted radial head fractures

Authors: Soo Min Cha, Sang Hyun Lee, In Ho Ga, Yong Hwan Kim, Seung Ho Lee

Published in: International Orthopaedics

Abstract

Purpose

We hypothesized that multiple absorbable screws/K-wires would be effective for native head preservation in comminuted radial head fracture fixation (com-RHFs).

Methods

Seventeen patients who met the inclusion criteria between 2018 and 2020 were included. Radiologic findings indicating proper union and clinical outcomes such as the range of elbow motion, visual analog scale score, and Mayo Elbow Performance Score were assessed prospectively after surgery and at least three years of follow-up.

Results

The mean follow-up period was 4.6 years. Eleven, one, three, and two patients presented with isolated com-RHFs, type 2 (accompanied injury of medial collateral ligament), type 4 (“terrible triad”) fractures, and type 5 posterior olecranon fracture-dislocations, respectively. Union was achieved after a mean of nine weeks postoperatively. The head and shaft angles did not differ significantly from the contralateral normal values (p = 0.778 and 0.872, coronal and sagittal, respectively). At the final follow-up, the mean flexion–extension/pronation-supination arcs were 126.47 ± 4.92°/135.59 ± 10.13°, and thus were significantly different from those on the contralateral side (p < 0.001, both), however the arcs were functional ranges for ordinary daily life. Also, functional status was satisfactory in all individuals. The arthritis grade and extent of heterotrophic ossification were satisfactory in all cases, and there were no serious complications requiring revision surgery.

Conclusions

Absorbable screw/K-wire fixation for com-RHFs is an option before radial head arthroplasty associated with a low complication rate and no need for revision.

Duckworth AD, Watson BS, Will EM, Petrisor BA, Walmsley PJ, Court-Brown CM et al (2011) Radial head and neck fractures: functional results and predictors of outcome. J Trauma 71(3):643–648. https://doi.org/10.1097/TA.0b013e3181f8fa5fCrossRefPubMed

Kupperman ES, Kupperman AI, Mitchell SA (2018) Treatment of Radial Head Fractures and Need for Revision Procedures at 1 and 2 Years. J Hand Surg Am 43(3):241–247. https://doi.org/10.1016/j.jhsa.2017.10.022CrossRefPubMed

Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y (2006) Comminuted fractures of the radial head: comparison of resection and internal fixation Surgical technique. J Bone Joint Surg Am 88(1):11–23. https://doi.org/10.2106/JBJS.E.00841CrossRefPubMed

Marsh JP, Grewal R, Faber KJ, Drosdowech DS, Athwal GS, King GJ (2016) Radial Head Fractures Treated with Modular Metallic Radial Head Replacement: Outcomes at a Mean Follow-up of Eight Years. J Bone Joint Surg Am 98(7):527–535. https://doi.org/10.2106/JBJS.15.00128CrossRefPubMed

Ring D (2008) Displaced, unstable fractures of the radial head: fixation vs. replacement–what is the evidence? Injury 39(12):1329–1337. https://doi.org/10.1016/j.injury.2008.04.011CrossRefPubMed

Hall JA, McKee MD (2005) Posterolateral rotatory instability of the elbow following radial head resection. J Bone Joint Surg Am 87(7):1571–1579. https://doi.org/10.2106/JBJS.D.02829CrossRefPubMed

Ruchelsman DE, Christoforou D, Jupiter JB (2013) Fractures of the radial head and neck. J Bone Joint Surg Am 95(5):469–478. https://doi.org/10.2106/JBJS.J.01989CrossRefPubMed

Chen X, Wang SC, Cao LH, Yang GQ, Li M, Su JC (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):1071–1076. https://doi.org/10.1007/s00264-010-1107-4CrossRefPubMed

Schnetzke M, Aytac S, Deuss M, Studier-Fischer S, Swartman B, Muenzberg M et al (2014) Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF. Int Orthop 38(11):2295–2301. https://doi.org/10.1007/s00264-014-2478-8CrossRefPubMed

10.

Al-Burdeni S, Abuodeh Y, Ibrahim T, Ahmed G (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):1659–1664. https://doi.org/10.1007/s00264-015-2755-1CrossRefPubMed

11.

Watters TS, Garrigues GE, Ring D, Ruch DS (2014) Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Clin Orthop Relat Res 472(7):2128–2135. https://doi.org/10.1007/s11999-013-3331-xCrossRefPubMed

12.

Burns AE, Varin J (1998) Poly-L-lactic acid rod fixation results in foot surgery. J Foot Ankle Surg 37(1):37–41. https://doi.org/10.1016/s1067-2516(98)80009-4CrossRefPubMed

13.

Lee BJ, Lee CH, Lee YH, Woo S (2023) Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases. Eur J Orthop Surg Traumatol 33(7):2911–2920. https://doi.org/10.1007/s00590-023-03503-3CrossRefPubMed

14.

Kuhlmann J, Bartsch I, Willbold E, Schuchardt S, Holz O, Hort N et al (2013) Fast escape of hydrogen from gas cavities around corroding magnesium implants. Acta Biomater 9(10):8714–8721. https://doi.org/10.1016/j.actbio.2012.10.008CrossRefPubMed

15.

Poinern GEJ, Brundavanam S, Fawcett D (2012) Biomedical magnesium alloys: a review of material properties, surface modifications and potential as a biodegradable orthopaedic implant. Am J Biomed Eng 2(6):218–40. https://doi.org/10.5923/j.ajbe.20120206.02CrossRef

16.

Waizy H, Diekmann J, Weizbauer A, Reifenrath J, Bartsch I, Neubert V et al (2014) In vivo study of a biodegradable orthopedic screw (MgYREZr-alloy) in a rabbit model for up to 12 months. J Biomater Appl 28(5):667–675. https://doi.org/10.1177/0885328212472215CrossRefPubMed

17.

Caputo AE, Burton KJ, Cohen MS, King GJ (2006) Articular cartilage injuries of the capitellum interposed in radial head fractures: a report of ten cases. J Shoulder Elbow Surg 15(6):716–720. https://doi.org/10.1016/j.jse.2006.01.007CrossRefPubMed

18.

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

19.

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

20.

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):123–132CrossRefPubMed

21.

Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMed

22.

Fleiss JL, Cohen J (1973) The equivalence of weighted Kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 33(3):613–639CrossRef

23.

Doro C, Hayden RJ, Louis DS (2006) Complex regional pain syndrome type I in the upper extremity. Clin Occup Environ Med 5(2):445–454. https://doi.org/10.1016/j.coem.2005.11.006CrossRefPubMed

24.

Bain GI, Ashwood N, Baird R, Unni R (2005) Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am 87(1):136–147. https://doi.org/10.2106/JBJS.D.02710CrossRefPubMed

25.

Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83(8):1201–1211. https://doi.org/10.2106/00004623-200108000-00010CrossRefPubMed

26.

Popovic N, Gillet P, Rodriguez A, Lemaire R (2000) Fracture of the radial head with associated elbow dislocation: results of treatment using a floating radial head prosthesis. J Orthop Trauma 14(3):171–177. https://doi.org/10.1097/00005131-200003000-00004CrossRefPubMed

27.

Antuña SA, Sánchez-Márquez JM, Barco R (2010) Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old. J Bone Joint Surg Am 92(3):558–566. https://doi.org/10.2106/JBJS.I.00332CrossRefPubMed

28.

Iftimie PP, Calmet Garcia J, de Loyola Garcia Forcada I, Gonzalez Pedrouzo JE, GinéGomà J (2011) Resection arthroplasty for radial head fractures: Long-term follow-up. J Shoulder Elbow Surg 20(1):45–50. https://doi.org/10.1016/j.jse.2010.09.005CrossRefPubMed

29.

Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y (2005) Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am 87(1):76–84. https://doi.org/10.2106/JBJS.C.01323CrossRefPubMed

30.

O’Connor CM, Kortlever J, Vagner GA, Reichel LM, Ring D (2022) Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture. Hand (N Y) 17(2):308–312. https://doi.org/10.1177/1558944720918358CrossRefPubMed

31.

Hackl M, Wegmann K, Hollinger B, El-Zayat BF, Seybold D, Gühring T et al (2019) Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases. J Shoulder Elbow Surg 28(8):1457–1467. https://doi.org/10.1016/j.jse.2018.11.047CrossRefPubMed

32.

Hopf JC, Rommens PM, Dietz SO, Müller LP, Krieglstein CF, Koslowsky TC (2019) Reconstruction of Complex Radial Head Fractures Using Fine-Threaded K-wires : Clinical Outcome and Remaining Instability. Acta Orthop Belg 85(4):437–447PubMed

33.

Lee JW, Han HS, Han KJ, Park J, Jeon H, Ok MR et al (2016) Long-term clinical study and multiscale analysis of in vivo biodegradation mechanism of Mg alloy. Proc Natl Acad Sci U S A 113(3):716–721. https://doi.org/10.1073/pnas.1518238113CrossRefPubMedPubMedCentral

34.

Guo L, Li R, Yang X, Yu C, Gui F (2020) Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: A retrospective study of 40 patients. Injury 51(10):2253–2258. https://doi.org/10.1016/j.injury.2020.07.041CrossRefPubMed

35.

Tarallo L, Mugnai R, Rocchi M, Capra F, Catani F (2018) Comparison between absorbable pins and mini-screw fixations for the treatment of radial head fractures Mason type II-III. BMC Musculoskelet Disord 19(1):94. https://doi.org/10.1186/s12891-018-2014-xCrossRefPubMedPubMedCentral

36.

Gregori M, Zott S, Hajdu S, Braunsteiner T (2019) Preserving the radial head in comminuted Mason type III fractures without fixation to the radial shaft: a mid-term clinical and radiographic follow-up study. J Shoulder Elbow Surg 28(11):2215–2224. https://doi.org/10.1016/j.jse.2019.07.036CrossRefPubMed

37.

Crönlein M, Zyskowski M, Beirer M, Imhoff FB, Pförringer D, Sandmann GH 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):789–795. https://doi.org/10.1007/s00402-017-2693-zCrossRefPubMed

38.

Smith GR, Hotchkiss RN (1996) Radial head and neck fractures: anatomic guidelines for proper placement of internal fixation. J Shoulder Elbow Surg 5(2 Pt 1):113–117. https://doi.org/10.1016/s1058-2746(96)80005-xCrossRefPubMed

39.

Jeon IH, Chun JM, Lee CS, Yoon JO, Kim PT, An KN et al (2012) Zona conoidea of the elbow: another articulation between the radial head and lateral trochlear of the elbow. J Bone Joint Surg Br 94(4):517–522. https://doi.org/10.1302/0301-620X.94B4.27842CrossRefPubMed

Title: Usefulness of multiple bioabsorbable Mg screws/K‑wires for comminuted radial head fractures
Authors: Soo Min Cha
Sang Hyun Lee
In Ho Ga
Yong Hwan Kim
Seung Ho Lee
Publication date: 08-05-2024
Publisher: Springer Berlin Heidelberg
Keywords: Radial Head Fracture
Radial Head Fracture
Elbow Injury
Published in: International Orthopaedics
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-024-06208-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Usefulness of multiple bioabsorbable Mg screws/K‑wires for comminuted radial head fractures

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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