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OBJECTIVE@#To compare the biomechanical stability of three cross-bridge headless compression screws and locking plates in the fixation of Mason type Ⅲ radial head fractures by finite element method.@*METHODS@#Using reverse modeling technology, the radial CT data and internal fixation data of a healthy 25-year-old male were imported into the relevant software. Three-dimensional finite element model of 3 cross-bridge headless compression screws and locking plates for MasonⅢ radial head fractures were established, and the radial head was loaded with 100 N axial loading. The maximum displacement, maximum Von Mises stress and stress distribution of the two groups were compared.@*RESULTS@#The maximum displacements of the three cross-bridge screws group and locking plate group were 0.069 mm and 0.087 mm respectively, and the Von Mises stress peaks were 18.59 MPa and 31.85 MPa respectively. The stress distribution of the three screws group was more uniform.@*CONCLUSION@#Both internal fixation methods can provide good fixation effect. CoMPared with the locking plate fixation method, the 3 cross-bridge headless compression screws fixation is more stable and the stress distribution is more uniform.
Subject(s)
Male , Humans , Adult , Finite Element Analysis , Radial Head and Neck Fractures , Bone Screws , Biomechanical Phenomena , Radius Fractures/surgery , Fracture Fixation, Internal/methods , Bone Plates , Fractures, ComminutedABSTRACT
Background: The functional stability of the elbow joint can be effectively restored in acute care for comminuted radial head fractures (RHFs) complicated with secondary ligamentous or bony injuries through the use of a metallic radial head implant. Aims and Objectives: This study aimed to evaluate the efficiency of modular metallic radial head implant EVOLVE® prosthesis in restoring the functional range of motion and elbow joint stability in acute care. Materials and Methods: A prospective observational study was conducted in the department of orthopedics at a tertiary-level care hospital in North India from April 2021 till March 2022. All consecutive patients above 18 years of age, with comminuted closed RHF, were included in the study. All underwent modular metallic head radial head implantation. The Mayo Elbow Performance Score (MEPS) was used to measure functional outcomes. Results: We observed that MEPS at 1-month follow-up was 81.54 ± 11.18, which improved significantly at the 3rd-month follow-up to 87.24 ± 12.42 (P < 0.001). On the next follow-up at the 6th month, MEPS increased further to 92.14 ± 7.36, P < 0.001. At the final follow-up at the 6th month, MEPS was graded as excellent for 80%, good for 12%, fair for 4%, and poor for 4%. One patient had complex regional pain syndrome and one had joint stiffness. Conclusion: The use of a modular radial head prosthesis has shown promise in treating comminuted RHF by re-establishing elbow joint stability in acute setting. This study demonstrated promising short-to-midterm results for the modular radial head arthroplasty.
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Abstract Objective To evaluate the functional results of patients submitted to a surgical approach for the treatment of the terrible triad of the elbow, analyzing the treatment methods used and associated epidemiological variables. Methods Patients who underwent surgical treatment for the terrible triad of the elbow from February 2018 to June 2020 at our service were evaluated. The identified sample consisted of 17 patients, but of these, only 13 completed all stages of the study and, therefore, were considered as the universe to be considered. Epidemiological information of interest was collected: age, sex, hand of dominance, affected side, characteristics and classification of injuries, trauma mechanism, time to surgery, type of procedure performed and range of motion. The Mason classification was used for radial head fractures and the Regan and Morrey classification for the coronoid process. In order to perform a functional analysis, the DASH and BRUCE questionnaires were applied. Results About 77% of the patients were male, 92% of the fracture mechanisms were due to high-energy trauma. Contrary to this, the predominance of the non-dominant side was observed as the most affected. Evaluating the results according to the time to start the treatment, the patients operated within 14 days had statistically better functional results. Conclusion Surgical treatment of TTIE generates acceptable functional results in most cases. The success of the treatment is related to the time interval between the trauma and the first surgery, in addition to the severity of the injuries.
Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a abordagem cirúrgica para o tratamento da tríade terrível do cotovelo, analisando os métodos de tratamento utilizados e variáveis epidemiológicas associadas. Métodos Foram avaliados pacientes submetidos aotratamento cirúrgico de tríade terrível do cotovelo de fevereiro de 2018 a junho de 2020 em nosso serviço. A amostra identificada foi de 17 pacientes, mas destes apenas 13 concluíram todas as etapas das pesquisas e por isso foram considerados como o universo a ser levado em consideração. Coletou-se informações epidemiológicas de interesse: idade, sexo, dominância, lado acometido, características e classificações das lesões, mecanismo do trauma, tempo para cirurgia, tipo de procedimento realizado e o arco de movimento. Foi utilizada a classificação de Mason para a fratura de cabeça do rádio e a de Regan e Morrey, para o processo coronoide. A fim de realizar uma análise funcional, aplicou-se os questionários de DASH e BRUCE. Resultados Cerca de 77% dos pacientes foram do sexo masculino, 92% dos mecanismos de fratura foram por trauma de alta energia. Contrariamente a esta, observou-se a predominância do lado não dominante como o mais afetado. Avaliando os resultados de acordo com o tempo para início do tratamento, os pacientes operados em até 14 dias obtiveram resultados funcionais estatisticamente melhores. Conclusão O tratamento cirúrgico da TTC gera resultados funcionais aceitáveis na maioria dos casos. O sucesso do tratamento está relacionado ao intervalo de tempo entre o trauma e a primeira cirurgia, além de se relacionar com a gravidade das lesões.
Subject(s)
Humans , Male , Female , Ulna/injuries , Elbow Joint , Elbow Injuries , Radial Head and Neck FracturesABSTRACT
Objective:To characterize the radial head fracture combined with capitulum cartilage injury (CCI).Methods:The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics, The Ninth People's Hospital of Wuxi from January 2011 to May 2020. They were 62 males and 48 females, aged from 17 to 74 years (average, 44.10 years). According to the finding of intraoperative exploration whether CCI was complicated or not, they were assigned into a CCI group and a CCI-free group. The diagnosis, location, size, type, operation method and postoperative recovery of CCI were observed in CCI group. The 2 groups were compared in terms of preoperative general data, range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score (MEPS).Results:CCI was complicated in 25 cases (type Ⅰ in 7 ones, type Ⅱ in 12 ones and type Ⅲ in 6 ones), involving all Mason types of radial head fracture, and located at the lateral capitellum in 13 cases, at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases. CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48% (12/25) for missed diagnosis. The preoperative flexion and extension (61.8°±13.7°) and rotation (60.0°±24.2°) in CCI group were significantly less than those in CCI-free group (77.7°±23.0° and 79.9°±21.9°) ( P<0.05); the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group ( P<0.05). There was no significant difference between the 2 groups in age, gender, combined injury, treatment of radial head fracture, follow-up time, range of forearm motion at the last follow-up or MEPS score ( P>0.05). Conclusions:CCI was complicated in 22.73%(25/110) of the radial head fractures in this cohort and found in all Mason types of radial head fracture, and mostly located at the lateral and posterolateral capitellum. CCI is likely to be missed by imaging examination. In patients with mild radial head fracture and suspected CCI, positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication. Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.
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BACKGROUND; In the treatment of radial head fractures, complications such as nonunion and internal fixation are inevitable in open reduction and internal fixation, resulting in chronic pain and dysfunction of the elbow joint. In order to reduce surgical complications and improve the success rate of surgery, radial head replacement surgery came into being. OBJECTIVE; To systematically compare the effects of radial head arthroplasty and open reduction and internal fixation in the treatment of Mason type III and IV radial head fractures by meta-analysis. METHODS: The search included clinical controlled studies published at home and abroad between 1999 and March 2019, with or without randomization and blinding. The databases included Embase, PubMed, Central, Cinahl, PQDT, CNKI, VIP, WanFang, Cochrane Library, and CBM. Magazine contents and references were manually retrieved to find grey references such as unpublished academic papers, and chapters in monographs. The language was not limited. All relevant articles were searched. If necessary, the articles were translated. The forearm rotation motion, forearm flexion mobility, postoperative joint function score, postoperative imaging evaluation results, postoperative complications and reversion cases were used as measurement outcomes so as to sufficiently compare the curative effects of arthroplasty and open reduction and internal fixation for treating Mason III type and IV of radial capitulum fracture. RESULTS AND CONCLUSION: (1) According to the above search strategy, 301 related articles were retrieved. (2) By reading the title and abstract, 146 irrelevant articles were excluded, and 155 related articles were screened initially. The full text was further read and screened strictly according to the inclusion criteria and exclusion criteria, and finally seven foreign articles were included. (3) In the Beoberg-Morrey scoring system [95%C/ (7.96, 23.14), P < 0.000 1], flexion and extension range [95%C/ (3.72,13.13), P=0.000 4], forearm pronation activity [95%C/ (2.09, 3.18), P< 0.000 01], rotation range of motion [95%C/ (2.80, 17.45), P=0.007], radial head arthroplasty was superior to open reduction and internal fixation. The number of postoperative complications in the radial head arthroplasty was less than that in the open reduction and internal fixation group [95%C/ (0.15, 0.57), P=0.000 3]. (4) In summary, in the treatment of Mason type III and IV radial head fractures, radial head arthroplasty is superior to open reduction and internal fixation.
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BACKGROUND: At present, open reduction and internal fixation is an effective method for the treatment of Mason type II radial head fracture. The selection of internal fixation includes screws, micro plates, Kirschner wires, absorbable rods or nails. The clinical efficacy reported is inconsistent. OBJECTIVE: To compare the clinical efficacy of titanium alloy screws or absorbable rod for the internal fixation of Mason type II radial head fractures. METHODS: Totally 25 patients with radial head fractures were collected from January 2016 to February 2017 in Sichuan Provincial People’s Hospital, including 16 males and 9 females, at the age of 38-61 years. All patients received open reduction and internal fixation. Of them, 13 cases received titanium alloy screws, and 12 cases received absorbable rod. X-ray images were obtained during follow-up to identify fracture healing time. During the final follow-up, visual analogue score, elbow motion range, Mayo elbow joint function score and Broberg-Morrey scores were compared between the two groups. The study was approved by the Ethics Committee of Sichuan Provincial People’s Hospital Sichuan Academy of Medical Sciences. RESULTS AND CONCLUSION:(1) There was no significant difference in fracture healing time between the absorbable rod group(2.35±0.92 months) and titanium alloy screw group(2.10± 0.47 months)(P > 0.05).(2) In the final follow-up, there was no significant difference in Mayo elbow joint function score and Broberg-Morrey scores between the two groups(P > 0.05).(3) In the final follow-up, there was no significant difference in elbow flexion, extension, supination, and pronation angle between the two groups(P > 0.05).(4) In the final follow-up, there was no significant difference in visual analogue score between the two groups(P > 0.05).(5) These results indicate that the absorbable rod and titanium alloy screws can obtain satisfactory treatment outcomes for Mason type II radial head fractures. However, the absorbable rod can avoid the secondary operation for removing internal fixators, and the adverse impact of stress shielding.
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@#Introduction: The aim of our retrospective study was to investigate the role of the medial side involvement in the treatment choice of radial head fractures. Materials and Methods: We searched the databases of our institutions for the surgical procedures diagnosed as "fracture of the radial head" and for the procedures related to "prosthesis of the radial head" and "osteosynthesis of the radial head" in the period from May 2014 to October 2017. The fractures were first classified according to the Mason classification . We then allocated the patients into three study groups according to the site of the fracture, either the medial or lateral side of the radial head : Group A, with an isolated lateral fracture of the radius head; Group B1, with a medial fracture of the radius head with two medial fragments; and Group B2, with a medial fracture of the radius head with multiple medial fragments. We performed a multivariate analysis to identify statistically significant correlation between the pre-operative classifications of Mason and our study, the type of surgical procedure, and the clinical outcome. Results: Mayo Elbow Performance (MEP) scores determined at the final follow-up of the study (mean 16.6 months, range 12-26 months) was excellent in 17 patients (4 in Group A, 6 in Group B1 and 7 in Group B2), and good in 12 patients (3 in Group A, 7 in Group B1, and 2 in Group B2). One patient showed a poor result in MEP score probably because of an infection and implant removal. Conclusion: Regarding medial fractures of the radial head, our study showed satisfactory results with a radial head prosthesis for comminuted or multifragmentary radial head fractures. For surgeons with advanced elbow fracture expertise, osteosynthesis could be attempted in a fracture pattern that involved only two medial fragments.
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Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture.Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason type Ⅲ who had been admitted to the Department of Hand Surgery,Wuhan Pu'ai Hospital from January 2013 to December 2016.They were 28 males and 32 females,aged from 26 to 71 years (average,54.5 years).Of them,41 underwent open reduction and internal fixation (incision group) and 19 radial head replacement (replacement group).The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation.A volume-weighted ratio R corresponding to a specific radial head fragment was calculated.Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated.At the last follow-up,the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups.Results All the 60 patients were followed up for 20 to 36 months (mean,28.6 months).At the last follow-up,the Broberg-Morrey elbow function score was 86.5 ±1.3 points (from 72 to 91 points) for the incision group and 93.6 ± 1.4 points (from 78 to 95 points) for the replacement group;the complication rate was 17.1％ (7/41) for the former and 15.8％ (3/19) for the latter.There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group.The linear regression equation between the two was:y=65.63+0.67x (R2=0.85,P=0.0006).There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group (P =0.053).When the Broberg-Morrey elbow joint function score (93.6 points) for the replacement group was substituted into the linear regression equation y =65.63 + 0.67x (y =93.6),x =41.7.Conclusions In the patients with radial head fracture of Mason type Ⅲ,open reduction and internal fixation may lead to a better prognosis for those with a volume ratio ≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio ＜41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis.
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Objective To compare the clinical efficacy of aescuven fort and indomethacin in the prevention of heterotopic ossification (HO) after operative treatment of radial head fractures with anterior bundle of medial collateral ligament(AMCL) injury.Methods A total of 41 patients with radial head fracture combined with AMCL injury leading to elbow valgus instability were randomly divided into 21 cases of the observation group(aescuven fort) and the 20 cases of control group(indomethacin),and were treated with aescuven fort of 600rng/d and indomethacin of 75rng/d for 6 weeks respectively.The incidence of adverse reactions of gastrointestinal tract in the two groups was statistically analyzed,and symptomatic treatment was given.Six weeks later,the incidence of HO was recorded by X-ray examination of the elbow joint.The range of motion (ROM) was recorded,and the excellent and good rate of the improved HSS score was calculated.The results were statistically analyzed.Results The incidence rates of gastrointestinal side effects in the observation group and control group were 9.5％ and 35.0％,respectively,and the difference was statistically significant between the two groups(x2 =4.651,P =0.027).The incidence rate of HO in the observation groupwas 14.3％,which in the control group was 15.0％,there was no significant difference between the two groups(x2 =0.206,P =0.948).The ROM and excellent and good rate of the improved HSS score in the observation group and control group were [(119.2 ± 19.7) ° and 86.9％]and [(120.8 ± 16.3) ° and 88.7％],respectively,and the differences were statistically significant(t =2.023,P=0.613;x2 =0.176,P =0.675).Conclusion Aescuven fort can effectively prevent the formation of HO after operative treatment of radial head fracture with AMCL injury,similar with indomethacin.But the incidence rate of gastrointestinal side effects of aescuven fort is significantly lower than indomethacin.
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<p><b>OBJECTIVE</b>To investigate the clinical effects of medial and lateral approach in treating terrible triad of the elbow.</p><p><b>METHODS</b>From May 2010 from May 2014, 11 patients with terrible triad of the elbow were treated through medial and lateral approach. There were 6 males and 5 females, aged from 25 to 56 years with an average of 35.2 years old. The time from injury to operation was from 1 to 13 days with an average of 5.9 days. Fracture of radial head according to Mason typing, 2 cases were type I, 7 cases were type II, 2 cases were type III. Ulnar coronoid fracture according to Regan-Morrey typing, 3 cases were type I, 7 cases were type II, 1 case was type III. Postoperative complications were observed and Mayo elbow performance score(MEPS) was used to assess the elbow joint function.</p><p><b>RESULTS</b>All patients were followed up from 6 to 24 months with an average of 15.5 months. All fractures obtained healing with an average time of 14 weeks (ranged from 10 to 18 weeks). According to Mayo to assess the results, total score was 78.2±11.7, 2 cases got excellent results, 7 good, 1 fair, 1 poor. At final follow up, the mean range of motion was (108±21)° in flexion, (12±8)° in extension, (66±13)° in pronation, (28±18)° in supination. The varus angle of the elbow ranged from 5°to 8° in 3 cases and the valgus angle was 8° in 1 case.</p><p><b>CONCLUSIONS</b>Treatment of the terrible triad of the elbow through medial and lateral approach can obtain satisfactory clinical effects, restore the elbow stability, allow early motion postoperatively, and promote the joint functional rehabilitation.</p>
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PURPOSE: We report short-term results of radial head prosthesis using a unipolar loose fit stem in ten patients. MATERIALS AND METHODS: Ten patients with Mason type three radial head fracture, who received unipolar radial head arthroplasty from February 2010 to June 2011, were evaluated (mean follow-up: 22 months, range: 18-30 months). Subjects consisted of five men and five women. Range of elbow motion was measured. Mayo elbow performance index (MEPI) score was used for functional evaluation and periodic radiological imaging was performed to evaluate the stability of implant. RESULTS: After an average follow-up of 22 months, elbow stability was maintained in all cases, and the average range of motion of elbow flexion and extension was 6 to 130 degrees. Average range of pronation and supination was 66 and 74 degrees, respectively. MEPI score was evaluated as excellent in seven cases, and good in three cases. On final follow-up, radiological assessment showed implant stability in all cases without evidence of dislocation, subluxation, arthritis, periprosthetic osteolysis or heterotopic ossification. CONCLUSION: Based on our short-term follow-up, radial head arthroplasty with unipolar loose fit stem is a useful method for obtaining satisfactory outcome for unreducible comminuted radial head fractures.
Subject(s)
Female , Humans , Male , Arthritis , Arthroplasty , Joint Dislocations , Elbow , Follow-Up Studies , Head , Ossification, Heterotopic , Osteolysis , Pronation , Prostheses and Implants , Range of Motion, Articular , SupinationABSTRACT
PURPOSE: Radial head fractures are the most common elbow fractures in adults, and are often accompanied with elbow dislocation resulting in various complications. This study examined the outcome of surgical treatment of a radial head fracture and its prognostic factors. MATERIALS AND METHODS: From January 1997 to February 2004, a retrospective analysis was performed on 25 radial head fracture patients with an elbow dislocation, also including elbow fracture, whose follow-up data could be obtained for more than 12 months. The surgical results were evaluated according to the prognostic factors and the Mayo Elbow Performance Index, which assessed the elbow joint function and pain. RESULTS: According to the Mayo Elbow Performance Index, the results were excellent in 11 cases, good in 5 cases, fair in 5 cases, and poor in 4 cases. Cases with post-surgical elbow joint instability showed statistically meaningful poor outcomes. However, there were good in the groups without an accompanied fracture, with no open fracture, type II and III Mason classification, and fixation period 4 weeks or less. Correlation analysis revealed a younger age and shorter immobilization period to have better results, and the immobilization period showed the strongest correlations with the Mayo Elbow Performance index. CONCLUSION: In conclusion, younger age, less severe injury in the initial event and a shorter immobilization period are good prognostic factors in radial head fractures combined elbow dislocations.
Subject(s)
Adult , Humans , Classification , Joint Dislocations , Elbow Joint , Elbow , Follow-Up Studies , Fractures, Open , Head , Immobilization , Retrospective StudiesABSTRACT
[Objective]To introduce the new concept of "terrible triad of the elbow",and report the preliminary results of 5 clinical cases.[Method]From April 2004 to March 2007,five cases met the diagnosis of terrible triad,with posterior dislocation of elbow complicated with radial head and ulnar coronoid fractures.The radial head fractures were 4 in type Ⅱ and I in type Ⅲ according to Mason classification,and Ⅰ in type Ⅰ,Ⅲ in type Ⅱ and 1 in type Ⅲ according to Schatzker classification.The ulnar coronoid fractures were Ⅰ in type Ⅰ,Ⅳ in type Ⅱ according to Regan-Morrey classification,and all 5 in type Ⅰ according to O'Driscoll classification.Four patients underwent surgical operations.The fractured radial head and ulnar coronoid were reduced and fixed with 3mm titanic lag screws or K wires,the lateral and medial collateral ligaments were repaired with Krachow sutures.A plaster of Paris was applied for 3 weeks after operation,in position with elbow flexion in 90 degrees and forearm rotation in neutral.Then physical exercise and rehabilitation program were carried out.[Result]Four operated patients were followed up for 3 months to 3 years,with healed fractures,stable elbow and no pain movement.The average range of elbow flexion-extension were 120 degrees,and forearm pronationsupination were 110 degrees,respectively.The functional outcome in 3 cases that followed up more than Ⅰ year was excellent in 2 and good in Ⅰ according to Mayo Elbow Performance Score(MEPS).The result of the un-operated case was poor in MEPS evaluation.Elbow instability and pain was the main complaint.[Conclusion]Terrible triad of posterior dislocation with radial head and ulnar coronoid fractures is a severe trauma to the elbow.Operative osteosythesis and ligament repair is mandatory for concentric reduction and elbow stability.
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PURPOSE: To evaluate the clinical outcome for terrible triad injury of the elbow joint. MATERIAL AND METHODS: We reviewed consecutive 10 cases retrospectively among 12 terrible triad injuries, which had been followed up for a minimum 1 year. The average age at the time of injury was 45 years (range, 32~72). All cases were dislocated posteriorly. The 3 cases had fracture of olecranon. Combined medial and lateral approach was performed in 3 cases, medial and lateral approach after extensile posterior approach in 4 cases, transolecranon approach using existed olecranon fracture in 2 cases, and transolecranon approach in 1 case were done. RESULTS: The average Mayo elbow performance score was 87, with 5 excellent, 4 good, and 1 poor results. Results by Riseborough and Radin's rating criteria include 9 good and 1 fair. The 8 cases were stable. But 2 cases were classified with moderate and severe instability; these cases had been performed by radial head allograft and excision respectively. CONCLUSION: A stable, functional elbow can be restored in terrible triad injury by early active rehabilitation after anatomic reduction and firm internal fixation.
Subject(s)
Allografts , Joint Dislocations , Elbow Joint , Elbow , Head , Olecranon Process , Rehabilitation , Retrospective StudiesABSTRACT
Sixteen patients who had radial head fractures were treated with open reduction and internal fixation using Herbert screws (10 patients), and with silastic prosthetic replacement (6 patients) from March, 1992 to December, 1994 in Chungnam National University hospital. The average duration of follow up was 19.5 months. The purpose of this study is to examine the role of Herbert screw fixation and silicone replacement arthroplasty and to asscess the clinical results of two groups functionally, radiologically in raidial head fractures. By functional rating index (modified After B.F. Morrey et al), the results were classified as excellent (9 patients), good (6 patients), fair (No patient) and poor (1 patient). Nine of the ten patients treated by open reduction and internal fixation using Herbert screws had resulted in excellent or good. All patients were inserted silastic implants were showed excellent or good results. Especially, in Mason Type III radial head fractures, three of four patients treated by Herbert screws and all 5 patients treated by silastic prosthesis were considered to excellent or good results. We concluded that Herbert screw fixation or silastic prosthetic replacement had satisfactorily appeared to be the alternative treatment option for Mason Type III radial head fractures.