Functional outcomes of patients with comminuted radial head fracture undergoing radial head arthroplasty

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.

Complications after surgical treatment of jupiter's monteggia type ii fractures / Complicações após tratamento cirúrgico das fraturas de monteggia tipo ii de jupiter

ABSTRACT Monteggia fracture-dislocations are rare injuries, affecting about 2-5% of the population. Jesse Jupiter subdivided Bado's Type II fractures into four types, all of which presented an associated radial head fracture. Associated chondral and ligament injuries can evolve with postoperative complications. Objective: To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions. Methods: This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications. Results: A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes. Conclusion: The studied cases evolved with high rates of postoperative complications, mainly in Jupiter's Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.

RESUMO A fratura-luxação de Monteggia é uma lesão rara que acomete cerca de 2-5% da população. Jesse Jupiter subdividiu as fraturas tipo II de Bado em quatro tipos, todos eles associados à fratura da cabeça do rádio. As lesões condral e ligamentares associadas podem evoluir com complicações pós-operatórias. Objetivo: Avaliar a incidência das complicações e os fatores de risco que podem influenciar os resultados pós-operatórios nas fraturas de Monteggia tipo II de Jupiter. Métodos: Estudo retrospectivo com pacientes tratados cirurgicamente. Avaliaram-se as características relacionadas às fraturas e as técnicas cirúrgicas utilizadas e, em seguida, tais variáveis foram correlacionadas com complicações pós-operatórias radiográficas e funcionais. Resultados: Foram avaliados 15 pacientes, havendo predomínio do sexo masculino e maior prevalência das fraturas tipo IIA e IID. As complicações mais frequentes foram a ossificação heterotópica e a osteólise ao redor da prótese da cabeça do rádio. A instabilidade pós-operatória ocorreu somente no complexo ligamentar lateral. Funcionalmente, segundo o Mayo Elbow Performance Score, 53% dos pacientes evoluíram com resultados desfavoráveis. Conclusão: Observou-se alta taxa de complicação pós-operatória, principalmente nas fraturas tipo II-D de Jupiter e naquelas com fratura do coronoide associada. Nível de Evidência III, Estudo Terapêutico.

Postoperative Functional Evaluation in Patients Undergoing Surgical Treatment of the Terrible Triad Injury of the Elbow / Avaliação funcional pós-operatória em pacientes submetidos a tratamento cirúrgico da tríade terrível do cotovelo

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.

Treatment of isolated traumatic radial head dislocation after failed close reduction / 中华创伤骨科杂志

Objective:To explore the surgical treatment of isolated traumatic radial head dislocation (ITRHD) after failed close reduction.Methods:A retrospective study was conducted of the 8 patients with ITRHD who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for operation after failed close reduction from January 2011 to December 2020. They were 2 males and 6 females, aged from 15 to 41 years (average, 27 years). The left elbow was injured in 3 patients and the right elbow in 5. At the last follow-up, elbow flexion-extension and forearm pronation-supination were recorded and Mayo Elbow Performance Score (MEPS) was used to evaluate functional recovery.Results:The 8 patients were followed up for 2 to 13 months (mean, 4.5 months). At the last follow-up, elbow flexion-extension averaged 136.9° and forearm pronation-supination 143.8°. None of the 8 patients had significant pain or joint instability. Of them, 7 had good motor function but one reported significant limitation of forearm rotation. All the 8 patients scored a full MEPS mark.Conclusions:If close reduction failed, ITRHD should be treated in time by operative treatment the efficacy of which is reliable. Fixation of the proximal radial-ulnar joint with Kirschner wire should be avoided. Early exercise for full range of elbow motion is necessary.

Clinical characteristics of radial head fracture combined with capitulum cartilage injury / 中华创伤骨科杂志

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.

The Influence of Medial Comminution in the Treatment Choice of Radial Head Fracture

@#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.

Meta-analysis of radial head arthroplasty versus open reduction and internal fixation for treating radial head fractures / 中国组织工程研究

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.

Absorbable rod or titanium alloy screws for Mason type II radial head fractures / 中国组织工程研究

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.

A Study Of Morphology And Morphometry Of Proximal End Of Dry Radius Bones With Its Clinical Implications

Background: Fracture of the radial head constitute 1/3rd of all the elbow fractures. It occurs as a result of a fall onan outstretched hand or a direct blow to the lateral aspect of elbow joint. This is now becoming more commondue to pre existing co-morbidities like osteoporosis and chronic osteoarthritis. Surgical correction of thecomminuted fractures of radial head involves reconstruction or replacement with artificial radial head prosthesisin cases where reconstruction is not possible.Aims and Objectives: To analyze the morphometric details of proximal end of radius and to describe themorphological features of head and bicipital tuberosity of the radius.Materials & Methodology: Sixty dry human adult radius bones of unknown age and sex were assessed formorphometric and morphological characters. Vernier caliper was used to measure the various parameters onthe proximal ends of radius bones. The data was tabulated and analyzed using SPSS software.Results: The mean length of radius was found to be 23.98 cm. Antero-posterior diameter and transverse diameterof head was 2.01 cm and 1.98 cm respectively. The height of radial head at medial end, height of radial head atlateral end, depth of articular facet and radial head circumference were 0.91 cm ,0.73 cm, 2.91 cm, 4.78 cmrespectively. The length of neck of the radius, diameter of proximal end of neck of radius, diameter of distal endof neck of radius was 1.28 cm , 1.37 cm , 1.32 cm respectively. The width of bicipital tuberocity, length of bicipitaltuberocity were 1.21 cm, 2.29 cm respectively.Conclusions: Fractures of radial head and neck are more common. Surgical management of displaced andcomminuted radial head fractures needs replacement with radial head prosthesis when reconstruction is notindicated. The results of our study are important in making anatomically and biomechanically suitable radialhead prosthesis

Complicaciones a mediano plazo de la prótesis monopolar modular de cabeza radial / Mid-term complications of the monopolar, modular radial head prosthesis

Resumen: Introducción: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. Material y métodos: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). Resultados: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head) . La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. Discusión: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. Conclusión: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.

Abstract: Introduction: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. Material and methods: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). Results: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. Discussion: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. Conclusion: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.

Luxación congénita de cabeza radial: reporte de dos casos / Congenital radial Head dislocation: report of two cases

Resumen: Introducción: La luxación congénita de cabeza radial es un padecimiento que se ha descrito en contados casos en la literatura internacional, siendo la luxación anterior y lateral las formas de presentación menos frecuentes con 15% de los casos cada una y la luxación posterior la más frecuente con 70% del total de los casos reportados. Sin embargo, esta patología es considerada la patología congénita más frecuente del codo en el niño. Se presenta el caso de un paciente con luxación congénita de codo variedad anterior y otro caso con luxación variedad lateral, ambos diagnosticados a temprana edad, en los que se decidió realizar un manejo conservador y un seguimiento anual. Asimismo, se hizo una revisión bibliográfica del tema. Discusión: La luxación congénita de codo tiene por lo general una evolución benigna, siendo indolora y poco limitante para el paciente, por lo que puede ser manejada de manera conservadora. El dolor y la limitación de movimientos son indicativos de un tratamiento quirúrgico; sin embargo, no son ampliamente aceptados debido a las complicaciones y resultados deficientes que presentan.

Abstract: Introduction: Congenital dislocation of the Radial head is a condition that has been described in a few cases in the international literature, the anterior and lateral dislocation were the less frequent forms of presentation with 15% of cases, each, and the posterior dislocation the most frequent with 70% of the total cases reported. However, this pathology is considered the most frequent congenital pathology of the elbow in children. The present study describes the case of a patient with congenital dislocation of elbow anterior variety and another case with dislocation lateral variety, both diagnosed at an early age, in which it has been decided for conservative management and an annual follow-up. A bibliographic review of the subject is also carried out. Discussion: The congenital elbow dislocation usually has a benign evolution, being painless and not very limiting for the patient, so it can be managed conservatively. Pain and limited movement are indicative of surgical treatment. There are multiple surgical treatments for this entity, however they are not widely accepted due to the complications and poor results presented by them.

Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

PURPOSE: Radial head fractures, which account for 33% of all fractures, are treated depending on the Mason classification. In comminuted type 3 fractures, open reduction internal fixation (ORIF), and radial head arthroplasty are the treatment options. This study examined the clinical outcome of modified Mason type 3 radial head fractures using ORIF with a plate. MATERIALS AND METHODS: The medical records and image of 33 patients, who underwent ORIF for modified Mason type 3 radial head fractures, were reviewed retrospectively. The preoperative plain radiographs and computed tomography images were used to examine the location of the fracture of the radial head, the number of fragments, union, joint alignment, and traumatic arthritis at the final follow-up. The range of motion (ROM) of the elbow at the last follow-up, pain score (visual analogue scale), modified Mayo elbow score (MMES), and complications were analyzed for the clinical outcome. RESULTS: Of the 33 cases, 14 were men and 19 were women. The mean age was 41.8 years and the average follow-up period was 19 months. The functional ROM was divided into three groups according to the number of bone fragments: 141.2°±9.3° of 3 (n=20), 123.8°±18.5° of 4 (n=7), 100.7°±24.4° of more than 4 (n=6). Furthermore, the MMES were 88.2±2.9, 83.7±4.3, and 77.3±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7°±7.5° and 82.1±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1°±3.8° and 89.9±3.2 on the radial aspect. CONCLUSION: Various factors, such as the degree of crushing and location involved in the clinical outcome. In particular, the result was poor in the case of more than four comminuted fragments or chief position located in the ulnar aspect. In this case, radial head arthroplasty may be considered in the early stages.

Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first? / 中华创伤杂志(英文版)

Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.

Radial head subluxation in pediatric clinics and emergency departments in China / 中华创伤杂志(英文版)

Purpose:@#To investigate the characteristics of the onset and treatment of radial head subluxation (RHS) in pediatric clinics and emergency departments.@*Methods:@#A retrospective study was performed on 11, 404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018. The patients who with history of trauma and fracture of the affected limb were excluded. The following factors were examined: the mechanisms of RHS, the type of manual reduction, the attending physician's clinical background (emergency surgeon, junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon), and the epidemiological features (gender, age, climate and location) of the injury.@*Results:@#The mean age of the patients was 27.93 ± 17.94 months (range 0.93-214.53 months), with a peak incidence of 10.73-44.53 months. Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December. Females accounted for 53.81% (n = 6137) of the cases, and left injuries were predominant (56.87%, n = 6485) in all cases. Mechanisms of injury were classified as "pull" (90.57%, n =10, 339), "fall" (1.56%, n = 178), "hit" (0.75%, n = 86) and "unknown" (7.02%, n = 801). The overall success rate of manual reduction was 99.47%, and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons (p < 0.05). However, there was still a recurrence rate of 12.16% in the 9827 patients.@*Conclusion:@#Younger children are predisposed to RHS, and there is a possibility of recurrence. Trained emergency doctors can handle it well, but it is essential to refer patients to specialists when manual reduction failed.

Fragment volume and surgical methods in radial head fracture / 中华创伤骨科杂志

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.

Anatomical Parameters Of Radial Head: An Aid For Prosthesis Design

Introduction: Radial head and neck fractures are one of the commonly encountered traumatic injuries. Commonlyproposed management includes radial head prosthesis implant or open reduction and internal fixation dependingon type of injury. Radial head measurements are very valuable in reconstruction of radial head. Appropriateanatomy of radial head will help in preventing postoperative stiffness and enable good rehabilitation.Aims and objectives: To estimate and compare radial head parameters of proximal end of right and left radii.Materials and Methods: Radial head measurements -Height of radial head in medial (MH) and lateral (LH) side,Antero posterior diameter (APD) and transverse diameters (TD) of radial head, Thickness of ventral (TVC), lateral(TLC) and dorsal (TDC) curves and depth of articular facet (D) were measured with the help of digital caliper.Statistical analysis was done using SPSS software. Difference in sides was measured using independent sampleT test (p value < 0.05 considered significant).Results: Mean values of Radial head measurements were APD:19.81mm, TD:18.925mm, MH:9.795mm,LH:7.735mm,TVC:5.05,TDC:3.695,TLC:3.64,D:1.735.There was difference in values of TLC between right and leftsides.Conclusion: Mean values of radial head measurements were comparable with previous studies. Side differenceshould be considered while implanting prosthesis on affected side.

Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Clinical study of aescuven fort in the prevention of heterotopic ossification after operative treatment of radial head fractures with anterior bundle of medial collateral ligament injury / 中国基层医药

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.

Neuropatía por atrapamiento del nervio interóseo posterior en un adulto con displasia ósea / Entrapment neuropathy of the posterior interosseous nerve in an adult with bone displasia

Resumen: La neuropatía por atrapamiento del nervio Interóseo Posterior, rama motora del nervio radial, puede ser causada por la compresión estructural, mecánica, o dinámica en lugares específicos que conducen a la lesión del nervio. La proximidad del nervio interóseo posterior a la cabeza del radio lo hace susceptible a lesiones por eventos traumáticos agudos o crónicos, como manifestación tardía secundaria a luxación de la cabeza del radio. Esta última es una entidad poco frecuente en el adulto y siempre plantea diversos diagnósticos diferenciales referidos a su origen y eventual asociación con Acondroplasia. La patología compresiva del nervio Interóseo Posterior puede generar dos síndromes diferentes: Síndrome del nervio interóseo posterior o Síndrome del túnel radial. En este artículo se describe el caso de un adulto con una neuropatía por atrapamiento del nervio Interóseo Posterior, con subluxación unilateral de cabeza del radio y antecedentes personales de Displasia Ósea. A través del análisis de los estudios de electrodiagnóstico e imagenología, se plantean los diagnósticos diferenciales, etiológicos y diagnóstico positivo de Síndrome del nervio interóseo posterior. Así como su posibilidad de tratamiento conservador y quirúrgico.

Abstract: Entrapment neuropathy of the posterior interosseous nerve, motor branch of the radial nerve can be caused by structural, mechanical, or dynamic compression in specific locations that lead to nerve injury. The proximity of the posterior interosseous nerve to the radial head makes it susceptible to injury from acute or chronic traumatic events, such as late manifestation secondary to dislocation of the radial head. The latter is a rare entity in adults and always raises several differential diagnoses related to their origin and possible association with Achondroplasia. The compressive pathology of the posterior interosseous nerve can generate two different syndromes: posterior interosseous nerve syndrome or radial tunnel syndrome. This article describes the case of an adult with a posterior interosseous nerve entrapment neuropathy with unilateral radial head dislocation and personal history of Bone Dysplasia. Through analysis of electrodiagnostic and imaging studies, differential diagnoses, etiological and positive diagnosis of posterior interosseous nerve syndrome arise. As well as the possibility of conservative and surgical treatment.