Die bipolare Radiuskopfprothese bei nicht rekonstruierbaren Radiusk�pfchentr�mmerfrakturen: Indikation,Behandlung und Ergebnisse nach 5 Jahren

Abstract

The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

Mid- to long-term results after bipolar radial head arthroplasty

“…8 The observations of Popovic et al have to be interpreted differently, as the authors presumed that only the radiolucent lines that were already visible within the first postoperative year and remained stable overtime are the result of an insufficient cementing technique, and that the progressive radiolucent lines and proximal bone resorption occur due to mechanical factors and wear debris. Because these findings were not noted in any of the numerous short-term studies, 3,12,32,34 nor in Muller's, Dotzis', or Frosch's 5-year studies, 7,9,23 nor in our 8.8-year results of Judet's bipolar radial head prosthesis, one must assume that all these radiologic findings may be the result of an initial insufficient cementing technique, perhaps worsened by mechanical factors and/or wear debris over the years.…”

“…1,5,19,25 It has, therefore, superseded radial head resection as the treatment of choice for unreconstructable radial head fractures. 19,24,31 In many studies, encouraging short-term results have been reported for monobloc as well as bipolar implants 3,[7][8][9]12,17,18,21,23,27,32,34 ; but, there still exists a lack of information concerning long-term results.…”

Malpositioning of radial head prostheses: An in vitro study

“…) Several studies have shown good short-to midterm results of metal radial head prostheses. 1,4,6,7,8,10,11,15,18,19,28,31 However, only scarce data are available for their long-term outcome. 9 There is concern about the potential for long-term cartilage wear.…”

Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis

“…8 Eine 74-jährige Patientin, bei der es nach Ellenbogenluxation und Radiuskopfresektion mit ulnar-und radialseitiger Bandnaht zur wiederholten Luxation kam und der wir die Prothese sekundär am 62. Tag nach dem Unfall implantierten, erzielte subjektiv und funktionell ein befriedigendes Ergebnis.…”

“…Das Patientenkollektiv zeigte weder ein andauerndes Instabilitätsgefühl noch einen Cubitus valgus, eine Demineralisierung, eine Arthrose am Capitulum humeri oder Beschwerden im Handgelenk. Während der Einsatz bei Begleitverletzungen wie ulnarer Bandinstabilität und/oder Frakturen (Mason IV) anerkannt ist [8,9], sehen wir -wie Judet et al [12] -aufgrund der sehr guten und guten subjektiven Ergebnisse sowie der niedrigen intra-und postoperativen Komplikationsrate darü-ber hinaus die Indikation zur Implantation bei Monoverletzungen des Speichenkopfs (Mason III). …”