Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Abstract

Background Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial. Questions/purposes We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Methods Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Complete followup was available on 87% (39 of 45 patients).

Treatment of complex elbow fracture-dislocations

“…They suggested that the improved visualization of the coronoid during radial head excision and replacement led to more accurate internal fixation. It may also result in less soft tissue stripping and subsequently less instability after radial head arthroplasty [19]. In another study, Leigh and Ball [20] demonstrated no difference in outcomes between radial head arthroplasty and internal fixation in a retrospective, nonrandomized study.…”

“…Attempts at internal fixation for radial head fractures with more than three articular fragments have been associated with unsatisfactory results [18]. Using this as one indication for radial head arthroplasty, Watters et al [19] found no difference in functional outcomes or elbow motion compared to internal fixation after a mean follow-up of 24 months. Interestingly, the authors reported three elbows with persistent instability in the internal fixation group compared to no cases in the arthroplasty group [19].…”

“…Using this as one indication for radial head arthroplasty, Watters et al [19] found no difference in functional outcomes or elbow motion compared to internal fixation after a mean follow-up of 24 months. Interestingly, the authors reported three elbows with persistent instability in the internal fixation group compared to no cases in the arthroplasty group [19]. They suggested that the improved visualization of the coronoid during radial head excision and replacement led to more accurate internal fixation.…”

Fractures of the Radial Head

“…Presently, 2 retrospective studies exist comparing ORIF to radial head arthroplasty and neither found significant differences in outcomes at short-term follow-up. 67,68 Oversizing of the Fig. 11.…”

Chronische knöcherne Instabilitäten des Ellenbogengelenkes

“…Die Versorgung von komplexen Frakturen des Ellenbogens hat über die letzten Jahre mit der Einführung von winkelstabilen und anatomisch präformierten Implantaten für Radiuskopf-, Koronoidund Olekranonfrakturen, der Weiterentwicklung von Radiuskopfprothesen sowie dem besseren biomechanischen Verständnis der knöchernen und weichteiligen Gelenkstabilisatoren eine stetige Verbesserung erfahren [4,7,29,32,33,36,49]. Fälle übersehener oder initial fehleingeschätzter Instabilitäten sind selten, sie können jedoch zu einer chronischen Subluxations-oder Luxationsstellung des Ellenbogengelenkes führen.…”